Most states are moving most of their Medicaid patients into Medicaid managed care programs. As of 2011, 74% of Medicaid patients were in Medicaid managed care organizations (CMS data). The states contend that this shift will improve care coordination while reducing costs. What does this report from The Urban Institute show us?
Upcoding: Evidence from Medicare on Squishy Risk Adjustment By Michael Geruso, Timothy Layton The National Bureau of Economic Research, NBER Working Paper No. 21222, May 2015 Diagnosis-based subsidies, also known as risk adjustment, are widely used in US health insurance markets to deal with problems of adverse selection and cream-skimming. The widespread use of these […]
March Effectuated Enrollment Consistent with Department’s 2015 Goal HHS.gov, June 2, 2015 The Centers for Medicare & Medicaid Services today released a data snapshot providing a detailed look at how many consumers paid their premiums in 2015 and had “effectuated” coverage in March 2015. During Open Enrollment for 2015 Marketplace coverage, through February 22, about […]
This Cancer Doctor Is Leading the Attack on Astronomical Drug Prices By Robert Langreth and Cynthia Koons Bloomberg Business, June 1, 2015 As the one-year cost of cancer drugs edges up to $200,000 per patient, a top doctor from Memorial Sloan Kettering Cancer Center used his speech before a massive gathering of colleagues to call […]
2015 Milliman Medical Index Milliman, May 2015 In 2015, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $24,671 according to the Milliman Medical Index (MMI). The amount will almost certainly surpass $25,000 in 2016. This year, the growth rate has again […]
Antitrust Lawsuits Target Blue Cross and Blue Shield By Anna Wilde Mathews The Wall Street Journal, May 27, 2015 Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently […]
Assembly passes universal health care bill By Dan Goldberg Capital New York, May 27, 2015 The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure. The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. […]
The Post-Launch Problem: The Affordable Care Act’s Persistently High Administrative Costs By David Himmelstein and Steffie Woolhandler Health Affairs Blog, May 27, 2015 Last year we, and many others, drew attention to the chaotic and costly roll out of the Affordable Care Act’s (ACA) exchanges. The chaos is mostly over (unless King prevails over Burwell), […]
Health, Medicine and Justice: Designing a Fair and Equitable Healthcare System By Joshua Freeman, M.D. I hope that this book complements the others (by Donohoe, Geyman, Young, and others), offering a perspective that combines a physician’s knowledge of medical care and how it is delivered, a scholar’s understanding of the organization of the health system, […]
Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? By Atul Gawande The New Yorker, May 11, 2015 Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of […]
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