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...
Hospital Readmissions: Conditions, Cost, and Utilization Differences in Medicare, Medicaid, and Private InsuranceKip Piper -
Hospital readmissions are costly but largely preventable. Reducing inpatient readmissions are a top priority for Medicare, state Medicaid programs, and private health plans. The opportunities to lower costs and improve patient outcomes are considerable. Therefore, healthcare purchasers are realigning hospital payment methods to reward hospitals for fewer readmissions and...
Kip Piper -
The basis for medical treatment of heart disease is the belief that interventions like coronary angioplasty and bypass surgery are effective, and that their benefits outweigh the risks. Does this conviction stem from a solid scientific foundation, or might it be an illusion? Is it conceivable that both physicians and...
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....
To control rising health care costs and improve outcomes, health care purchasers - Medicare, state Medicaid programs, and large employers - and health plans are eager to entirely replace traditional, inefficient, volume-based fee-for-service (FFS) physician and hospital reimbursement with value-based payment models. Value-based payment comes in various flavors but...
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)...
Kip Piper -
Overuse and abuse of opioid drugs, particularly prescription pain killers, is a serious, costly problem, with a host of challenges for purchasers, payors, patients, physicians, pharmacists, regulators, public health, and drug manufacturers. For 20 years, overuse of opioid drugs has steadily increased, as have inpatient hospitalizations for opioid overdoses. Together, Medicaid and...
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 -
In the U.S., we usually hear about health care in Europe as an example of what the American health system is not. Universal health coverage, state-run provider networks, and rationing are the two differences that come up most often. But the U.S. and Europe share many health care policy challenges:...
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...
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