Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

Growth in health care spending has slowed recently.  Why?  Supporters of the Affordable Care Act (ACA) - aka Obamacare - says its due to the controversial law, although most of the ACA's provisions are yet to take effect.  However, new evidence shows that the economy is the cause of...
Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program serves veterans at risk of needing long term care for chronic conditions. Physician...
It’s not uncommon for a patient to be confused or overwhelmed by a diagnosis or treatment plan.  Complicated medical procedures or decisions can overwhelm patients to the point that they feel that they cannot, or should not, ask questions of their providers.   However, this lack of patient involvement in...
The nation's largest health care buyers - Medicare, state Medicaid programs, large employers, and health plans - are eager for ways to improve the quality and efficiency of chronic health conditions, which drive the bulk of health spending.  Payment reform and care delivery reforms are critically important.  Providers -...
Hospital admissions and readmissions are a hot topic in the healthcare community.  Reducing hospital utilization can result in a leaner, more efficient system with lower costs and greater health outcomes.  The opportunities to save money and improve care are extraordinary. Accordingly, Medicare, state Medicaid agencies, health plans, and patient organizations...
Primary care is shifting to payment based on providing higher quality, lower cost health care. New payment models - such as patient-centered medical homes (PCMH) - replace or supplement traditional fee-for-service payments with per-member per-month payments, and emphasize coordinated care, quality measurement, and accountability. Some models offer cost-sharing, as...
Medicare-Medicaid dual eligibles are often held up as a prime case for the need for better care management to reduce health costs and spending while improving quality.  But doing so can be challenging.  Most dual eligibles have multiple health conditions, whether a chronic disease, severe cognitive or physical disabilities,...
Coordinated primary care models have shown great potential to reduce health care costs while improving care, a goal that will become even more important after the Affordable Care Act (ACA) coverage expansion provisions take full effect next year. The models typically involve communication among providers, a focus on patients...
For the past several years, major payers in U.S. health care have experimented with new payment models that create incentives to control unnecessary health care spending. The traditional fee-for-service model for health insurance does not give providers a reason to control health costs: The more services they provide, the...
Health information technology, care coordination, and cost containment have increasingly become entwined in health care policy. Medicare and Medicaid both have electronic health record (EHR) incentive programs to encourage physicians, hospitals, and other providers to use them. Electronic patient communication also is part of care coordination models, such as...

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