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

State Medicaid programs will spend about $175 billion this year on health care for dual eligibles - low-income seniors and persons with disabilities who receive benefits from both Medicare and Medicaid.  State spending on dual eligibles falls primarily in three areas:  long term services and supports (nursing home, home...
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...
The Affordable Care Act (ACA) created a trade-off for providers, particularly hospitals: On the one hand, Medicare fee-for-service hospital payments will be cut by $260 billion over 10 years. Some people newly eligible for Medicaid will switch from private insurance, which pays much higher provider rates than Medicaid does....
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...
Fraud in the health care system is a significant and growing threat.  The FBI estimates that between 3% and 10% of all health care expenditures are lost to fraud each year - up to $280 billion annually.  Health care fraud not only raises costs for consumers and employers -...
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...
Medicare Part D, the Medicare drug benefit, served roughly 31 million seniors last year. Medicare Part D is more similar to Medicare Advantage than to traditional Medicare in that enrollees can choose among several private health plans for drug coverage. The lists of which drugs Part D plans cover -...
A painful fact about the U.S. health system is that roughly one third of health costs and spending are wasted. A study in the Journal of the American Medical Association (JAMA) found that wasted health spending could reach from about $500 billion to almost $1 trillion each year. And...

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