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Health care payment reform efforts focus on substituting cost-effective value for volume and ultimately aligning the financial incentives of provider reimbursement with expectations for patient outcomes, care management, and efficiency.  The complex dynamics and trade-offs of different payment reform models are discussed in a helpful new report from the Urban Institute...
The massive reforms to Medicare physician reimbursement mandated under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) present many issues and opportunities for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP).  While moving Medicare Part B to a new merit-based system of physician and clinic payment, MACRA also...
Childhood Diseases in Adulthood
Increased immunizations have reduced the rates of specific diseases associated with childhood. However, adults who are infected with the same viruses can experience dire consequences—and a vaccination in childhood may not guarantee immunity in middle age.  While the evidence supporting childhood vaccination and booster immunizations for adults is overwhelming, ignorance...
Global drug pricing continues to ignite fresh controversies as health policy makers, government health programs, health insurers, and pharmaceutical companies meet in heated debate. Solutions for health around the world rely on stakeholders having a clear understanding of the structure and logic behind drug pricing, but the complexities of the...
The medical goal for children diagnosed with pediatric cancers is remission or cure, but consistency and speediness of health insurance coverage is critical to access to preferred treatment. The therapeutic intervention differs based on the cancer type, stage, tolerance of the child to radiation and pharmaceutical agents, and numerous...
Controlling statewide costs in prisons was the rationale for privatizing the correctional healthcare delivery system across the nation, but there have been consequences.  The increased incarceration levels and shift from governmental to private criminal justice system medical care has resulted in an additional burden of care placed on hospitals...
The causes of autoimmune disorders such as lupus, diabetes (type 1), rheumatoid arthritis, and Sjogren’s syndrome have not been determined, but an abnormal immune response is the common feature. While symptoms are mild in some patients, these can be highly debilitating (and even life-threatening) in other individuals. Due to...
How have alternative health care payment models, aimed at lowering costs while improving patient outcomes, affected physicians and physician practices in the United States? A recent RAND Corporation study, sponsored by the American Medical Association, looks at the effects payment reform models have on physicians' finances, practice management, and...
Healthcare is undergoing a revolution in the transformation of data into credible, actionable information for decision making at all levels, including financing, coverage, reimbursement, product development, diagnoses and treatment, clinical care delivery, and consumer choices. In a fascinating new interview, one of the world’s top experts on health informatics discusses...
In a new episode of the MediStrategy podcast, Kevin Lewis, CEO of Community Health Options, shares insights on health insurance exchanges and the health plan business under the Affordable Care Act (ACA).  In an informative interview with Kip Piper, Mr. Lewis describes what it is like to launch and operate...

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