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

Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of healthy and sick enrollees, risk adjustment modifies premium payments to better reflect the projected costs of members served and...
Hospital costs are of keen interest to Medicare, Medicaid, and private health insurers these days, who pay the vast majority of hospital costs. Which services are the most expensive? Which types of health coverage are responsible for most of the costs? A new statistical brief from the Health Costs...
The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good example of that by showing that pregnant women in Medicaid with tobacco cessation coverage were less likely to smoke...
In the ongoing struggle over wasteful health care spending, geographic cost variation is a veteran hot topic. The fact that public programs and private health plans spend more for providers in some regions, even after accounting for normal differences in costs by location, has irked policymakers and researchers who...
The Department of Defense contracts with more than 11,000 health care professionals, at an annual cost of about $1 billion. A recent Government Accountability Office report says the military could do more to coordinate its contracting duties to save money and avoid duplication. Military Health Spending: The Military Health System provides...
Though most commonly associated with Medicare, Accountable Care Organizations are now making their way into state Medicaid programs. Providers, of course, are an essential part of the ACO model. But many providers don’t yet have the resources to coordinate care, analyze cost and usage data, and adapt to value-based...
Even as Accountable Care Organizations and other payment reform models become more common, there is still not much comprehensive information about which models providers participate in most often, and what exactly to do to make those arrangements work well. It is also important for providers to understand the best practices...
Billy Millwee, former Texas Medicaid director, recently published an excellent piece with insight into that state’s experience with quality-based payment reform. Health care payors, both private and public, are looking more and more to tie payment with outcomes. Millwee’s article is a thoughtful and thorough assessment of Texas Medicaid's...
Much about the Health Insurance Exchanges is uncertain, even as the October 1 deadline to make them operational approaches. Many states running their own or partnership exchanges have yet to decide on key elements of plan management, consumer outreach, and other important functions. Exchanges are a genuine game changer...
Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...

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