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Hospitals ask CMS to slow the deployment of new payment models
Health care providers are asking the Centers for Medicare and Medicaid Services (CMS) to slow the rollout of new payment models emphasizing value-based care. The Federation of American Hospitals argues the pace of change places an unreasonable burden on staffs and resources and CMS needs to perform a deeper study on the effects of pilot programs designed to test value-based models, explains Virgil Dickson of Modern Healthcare.
More mental health care available under Medi-Cal expansion
A law signed by California Governor Jerry Brown allows Medi-Cal, the state’s Medicaid program, to reimburse more categories of mental health providers beginning in 2017. The change doubles the number of specialists who may receive reimbursements from the program, writes Anna Gorman of California Healthline.
Medicaid expansion costs rising
The cost of expanding Medicaid is rising faster than expected in many states and causing budget concerns. As a result, at least three states that have expanded the program are pushing to require recipients to contribute more toward their health insurance. Associated Press reports this could lead to tens of thousands of low-income individuals going without coverage.
Special enrollments lead to higher costs
Consumers who sign up for health insurance during special enrollment periods, rather than in fall open enrollment, face higher costs, according to an analysis from research and consulting firm Avalere. Anthem, UnitedHealth Group and Aetna find special enrollments a challenge when estimating costs, as actuaries need information about individuals paying premiums to complete their risk planning. Bruce Japsen at Forbes shares the Obama administration and insurers are working together to limit special enrollments.
Consumers file suit regarding drug costs
UnitedHealth Group Inc. customers could be grossly overpaying for prescription drugs, according to a lawsuit filed Tuesday. According to the plaintiffs, UnitedHealth is pocketing the difference between the price of medication and the co-pay. UnitedHealth customers are responsible for the full co-pay of prescription drugs, yet the insurer has agreements with pharmacies to lower the cost. Kat Greene at Law360 has the story (subscriber’s content).
Studies of Note
In this feature, the Media Monitoring Report shares a selection of notable research studies within the health care industry.
Quality and Access
U.S. Colon Cancer Care Improves When Insurance Access Expands
October 5, 2016
A study led by Andrew Loehrer, M.D. MPH, of Massachusetts General Hospital Codman Center for Clinical Effectiveness in Surgery has found colon and rectal cancer patients receive better care in areas where insurance coverage has been expanded by Massachusetts’s 2006 health care reform law. The findings suggest an expansion in health insurance coverage may increase quality of care as well as access to treatment, explains Andrew Seaman of Reuters.
Cost of Premiums
Marketplace Plans with Narrow Physician Networks Feature Lower Monthly Premiums than Plans with Larger Networks
Researchers from the University of Pennsylvania find health insurance plans with smaller networks have a lower monthly cost than those with large networks. Researchers conclude implementing narrow networks can help insurers offer low-cost coverage options.
Excellent Emergency Treatment Can Add a Year to Heart Attack Victims’ Lives
October 5, 2016
On average, heart attack patients who receive emergency treatment from highly rated hospitals live a year longer than patients who receive care elsewhere. According to a study led by Boston Children’s Hospital researcher Emily Bucholz, M.D. PhD, quality of care in emergency treatment leads to long-term health benefits, explains Marilynn Marchione of Associated Press. Marchione emphasizes individuals who are suffering from a heart attack should seek immediate treatment at the nearest hospital, regardless of ratings.