The report examines the accuracy of the current CMS risk adjustment model for beneficiaries with functional limitations and the potential benefits of accounting for functional status in MA risk adjustment; and the potential challenges of accounting...White Papers, E books, Reports and more
This analysis provides state-by-state estimates of the impact on insurance coverage, premiums, and mandate penalty revenues if the states were to adopt individual mandates. The work is based on the Urban Institute’s Health Insurance Policy Simulation Model, assuming each state adopts an individual mandate similar to the ACA’s
If...White Papers, E books, Reports and more
No big clifflhanger here. Small and rural practices will continue to face technology challenges under MIPS as they had under previous legacy Medicare payment incentive programs.
The U.S. General Accountability Office's May 2018 report to Congress was based on interviews they conducted with 23 healthcare stakeholders, including small...White Papers, E books, Reports and more
MA covered 19 million lives in 2017 and ACA plans enrolled 12.2 million.
Beneficiaries in MA and ACA plans benefit from government subsidized coverage, a regulated market, guaranteed issue, community rating (or modified), benefit standards and risk adjustment.
This 2018, nine-page white paper from the Robert Wood Johnson...White Papers, E books, Reports and more
Based on data through 2018 and interviews with industry executive, health policy experts and health plan actuaries, the HRI report projects a 6 percent medical cost trend in 2019.
Medical cost trend is the projected percentage change of the costs for treating patients from one year to the next, assuming benefits remain the same....White Papers, E books, Reports and more
Based on an analysis by our friends at Milliman, this resource comes from America's Health Insurance Plans - spoiler alert, highest spend category: prescription drugs.
Take a look at the full premium breakdown by AHIP ...White Papers, E books, Reports and more
Get the first in a series of reports from the Commonwealth Fund on health reform in the 2020 election campaign.
This paper's key take-aways:
Campaign plans are used by supporters and the press to hold presidents accountable. Though voters are unlikely to believe...White Papers, E books, Reports and more
This paper from the USC-Brookings Schaeffer Initiative for Health Policy analyzes how insurance coverage among people with family incomes above 400 percent of the federal poverty level (FPL) has changed since 2013 and what's in store for ACA exchanges when the individual mandate ends in 2019.
Includes an analysis on how insurance...White Papers, E books, Reports and more
More than 60 percent of Americans have private health insurance; the updated health economics paper, "The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured," uses claims data from Aetna, Humana, and UnitedHealth.
The prices hospitals negotiate with health insurance companies vary enormously within and...White Papers, E books, Reports and more
The Department of Health and Human Services (HHS) has spent $35 billion since 2009 on health information technology. The Government Accountability Office (GAO) analyzed data from the CMS Electronic Health Record Incentive Program (Medicare EHR Program) and found that while patients described access to health information as beneficial,...White Papers, E books, Reports and more
The Henry J. Kaiser Family Foundation takes a deeper look at such policies, which are exempt from coverage requirements under the Affordable Care Act and are included in a new proposed rule to provide additional coverage options to American consumers.
Often considered major medical coverage, the policies are currenly allowed to offer...
Sometimes used as a substitute to an employer-sponsored health plan, the plans known as Christian Health Plans or Christian Ministries Plans are exempt from ACA provisions and may prove hazardous for employers.
This paper written by Fringe Benefit Analysts primarily focuses on the dangers and potential legal pitfalls an employer...
As AHCCCS makes its way across the state discussing with stakeholders about its interest in eliminating three-month retroactive coverage, this news brief provides an excellent backgrounder.
Arizona's Medicaid agency is seeking input on its interest in rolling back benefits to the month of application, consistent with policies prior to...
In this white paper from the Center for Healthcare Quality & Payment Reform, author Harold Miller outlines the strengths and weaknesses of FFS payment system, bundled payments and outlines numerous reasons why pay for performance, shared savings/shared risks programs aren't working.
Miller also discusses narrow and tiered...
In this white paper, the third in a series, McKinsey's Center for US Health System Reform explores initiatives state Medicaid programs can initiate to improve care delivery efficiency.
This white paper discusses initiatves in:
Care Delivery & Payment Innovation
Changes to Enrollment, Benefits...
In this white paper, The National Association of ACOs (NAACOS) turns its focus on the challenges facing healthcare organizations participating in the Medicare Shared Savings Program (MSSP) program and solutions that better support the program's sustainability.
NAACOS incorporates its findings from a recent survey of MSSP ACOs and it...
The Network for Excellence in Health Innovation (NEHI) recommends experimentation of value-based arrangements, especially for new cancer drugs.
This white paper recommends a combination of strategies to address:
Innovation & Experimentation
Advance Policy Measures
A roundup of the 2018 Medicare Advantage (MA) plans offered during the Annual Enrollment Period (AEP in Arizona across all counties beginning October 15, 2017
Members Only 2018 Medicare Advantage Spotlight Report
The nationwide survey conducted in March 2017 by Schoen Consulting asked 1,500 Americans about their experience with insurers including their perceived access to medications, screenings and medical procedures.
Those surveyed were receiving health insurance through an employer, Medicare or Medicaid. The Doctor Patients Rights Project...
A September data brief from the Office of the National Coordinator for Health Information Technology provides insight into how America's skilled nursing facilities (SNFs) are adopting electronic health records (EHRs) as well as their ability to electronically send, receive, find, integrate or use patient health information with other...