King v. Burwell: Using ACA Waivers to Continue Premium Subsidies in Federal Health Insurance ExchangeKip Piper -
In the King v. Burwell case on federal premium subsidies in the federally-run health insurance exchanges, Congress, the White House, and States have a simple option should the Supreme Court rule in favor of King. This option is a simple legislative fix likely to be scored at no cost...
Kip Piper -
While mountains of raw health care data continue to grow, the challenge of turning that data into usable, actionable information is largely being unmet. There are certainly tremendous new opportunities to use information to improve health care decisions at the purchaser, plan, provider, and patient levels and thereby improve...
Delivery of physical medical care and behavioral health services is too often uncoordinated, operating in silos with little or no communication between physicians and other providers providing a patient with primary, specialty, acute, and pharmacy services and behavioral health professionals proving that same patient with mental health care or...
Kip Piper -
Managed Long Term Services and Supports (MLTSS) programs provide long-term care primarily to aging adults and people with disabilities. This care is provided not via the fee-for-service model but through managed care organizations. These contractors deliver benefits, which include community, home, and institution-based services, and receive payment through Medicaid....
High hospital emergency room use by Medicaid enrollees is a perennial concern. What do we know about Medicaid emergency department visits? Are they medically necessary? What drives Medicaid emergency department visits? Is Medicaid ER utilization increasing under the Affordable Care Act? The Medicaid and CHIP Payment and Access Commission (MACPAC)...
State Innovations in Health Payment and Delivery Reform: $730 Million in New Federal Grants AvailableKip Piper -
States across the US are engaged in ambitious and critically important initiatives to reform health care payment and care delivery. Partnering with other major health care purchasers and payors, including employers and commercial health plans, State Medicaid agencies seek to improve health outcomes and decrease per capita health spending. This...
Kip Piper -
Throughout the new Health Insurance Exchanges, health plan offerings vary in premiums, cost sharing, and provider networks. As the Affordable Care Act’s radically new regulatory and financing framework plays out in the insurance market and with consumer and employer decisions, we can expect considerable change and variability from 2014...
Health Insurers Under Obamacare: Profit Margins, Risk, Adverse Selection, and Impact of ACA PoliciesKip Piper -
For health plans, the Affordable Care Act dramatically increases complexity and uncertainty in the health insurance market. One thing is clear - Obamacare turns traditional risk management practices of health plans upside down. Predicting and adapting to the financial and operational dynamics of ACA is a daunting challenge for health plans,...
Improving care integration for Medicare-Medicaid dual eligible beneficiaries is one of the many initiatives embedded in the Affordable Care Act (ACA). The health reform law created the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services (CMS), and provided funds for state demonstrations to integrate care for...
Kip Piper -
Medicare-Medicaid dual eligibles are often talked about as a single type of patient. They have significant levels of disability and chronic disease, and account for a disproportionately large spending in both Medicare and Medicaid budgets. But dual eligibles are a diverse group. A few recent studies into health spending on dual...
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