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Care Coordination in Medicare: What Works and for Whom?

Americans today are living longer than at any point in the nation’s history.  In a recent article in The Washington Post, Ezra Klein notes how this phenomenon and the prevalence of chronic illnesses is both challenging the U.S. health care system.

May 2013
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Americans today are living longer than at any point in the nation’s history.  Discoveries in the twentieth century largely eliminated infectious diseases as a significant contributor to American death rates, and more recent advances are helping people live with conditions that were once certainly fatal.  In a recent article in The Washington Post, Ezra Klein notes how this phenomenon and the prevalence of chronic illnesses is both c

Caring for Patients with Wise Resource Choices

Reducing health care costs dominates current health policy discussions, raising important questions about who is responsible for bending the cost curve. A recent article in The Boston Globe explores the challenges providers face in becoming better stewards of health care resources.

April 2013
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Reducing health care costs dominates current health policy discussions. A key question in these discussions is who is responsible for bending the cost curve? Steven Brill’s article in Time magazine examined the roles of manufacturers, hospital administrators, and health care providers.

Understanding the Effects of Balance Billing on Quality of Care

The cost of providing employer-sponsored insurance coverage continues to rise, and new legislation requires employers with at least 50 employees to offer affordable coverage or face a financial penalty. Employers are responding in a variety of ways to rein in their health expenditures while complying with these new regulations.

March 2013
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The cost of providing employer-sponsored insurance coverage continues to rise, and new legislation requires employers with at least 50 employees to offer affordable coverage or face a financial penalty. Employers are responding in a variety of ways to rein in their health expenditures while complying with these new regulations. One such option is to contract with payers who offer more fixed reimbursement rates.

Retail Health Clinics Continue to Grow in Popularity

Reducing health care costs and addressing the issue of primary care physician shortage are two issues at the forefront of the health policy discussion. Some have suggested that retail health clinics, or walk-in medical clinics located in pharmacies, superstores, and workplaces, could potentially address both of these issues.

February 2013
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Reducing health care costs and addressing the issue of primary care physician shortage are two issues at the forefront of the health policy discussion. Some have suggested that retail health clinics, or walk-in medical clinics located in pharmacies, superstores, and workplaces, could potentially address both of these issues. These clinics, a type of “disruptive innovation” in care delivery, are quickly gaining popularity.

Small-Employer Responses to ACA Provisions Extending Employee Insurance Coverage

One of the principal aims of the Affordable Care Act (ACA) is to expand access to affordable insurance coverage. Currently, individuals who receive employer-sponsored health insurance predominantly work for large employers. As such, small employers are a specific target in the ACA to expand access to coverage for their employees.

January 2013
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One of the principal aims of the Affordable Care Act (ACA) is to expand access to affordable insurance coverage. Currently, individuals who receive employer-sponsored health insurance predominantly work for large employers. As such, small employers are a specific target in the ACA to expand access to coverage for their employees.

Increasing Smoking Bans Improves Health

Smoking bans have become increasingly prevalent in public spaces including workplaces, bars, and restaurants. In a recent article in USA Today, Liz Szabo highlighted findings from several studies that describe the contribution of these policies toward significant health improvements.

December 2012
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Smoking bans have become increasingly prevalent in public spaces including workplaces, bars, and restaurants. In a recent article in USA Today, Liz Szabo highlighted findings from several studies that describe the contribution of these policies toward significant health improvements.

Medicare Penalty for Excess Hospital Readmissions

A recent article in The Denver Post discusses the CMS Hospital Readmissions Reduction Program, which penalizes hospitals with excess readmissions by withholding up to one percent of Medicare payments in the first year.

November 2012
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In an effort to reduce preventable and costly hospital readmissions, the Affordable Care Act (ACA) created the CMS Hospital Readmissions Reduction Program.  Starting October 1, 2012, Medicare will penalize hospitals with excess readmissions for heart attacks, heart failure and pneumonia within 30 days of discharge, withholding up to 1 percent of Medicare payments to hospitals for such readmissions.

Undocumented Immigrants Under Health Care Reform: A Growing Share of the Uninsured

As policymakers plan for major coverage gains under the Patient Protection and Affordable Care Act, there is increasing awareness of the groups that will be left out of health care reform.  Among these groups are undocumented immigrants, who are excluded from participation in exchanges, enrollment in the expanded Medicaid program, and other initiatives aimed at helping the uninsured gain coverage.

October 2012
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As policymakers plan for major coverage gains under the Patient Protection and Affordable Care Act (ACA), there is increasing awareness of the groups that will be left out of health care reform.  Among these groups are undocumented immigrants, who are excluded from participation in exchanges, enrollment in the expanded Medicaid program, and other initiatives aimed at helping the uninsured gain coverage.  As Nina Bernstein reports in

Assessing the Implications of the Medical Loss Ratio (MLR) Requirement

Individuals and businesses across the country received checks from their health insurance companies this summer under a provision in the Patient Protection and Affordable Care Act that targets insurers’ use of premium dollars.  Minimum medical loss ratios (MLRs) require insurers to spend a certain percentage of premium revenue on health care claims and quality improvement activities. 

September 2012
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Individuals and businesses across the country received checks from their health insurance companies this summer under a provision in the Patient Protection and Affordable Care Act (ACA) that targets insurers’ use of premium dollars.  Minimum medical loss ratios (MLRs) require insurers to spend a certain percentage of premium revenue on health care claims and quality improvement activities.  Under the ACA, insurers that do not meet new MLR standards must rebate the portion of premium dollars that exceeds the target.  An article by Ken Alltucker in

Medicare Observation Stays: When is a Hospitalization Not a Hospitalization?

A recent USA Today article by Susan Jaffe examines hospitals’ growing use of observation stays in lieu of fully admitting Medicare patients. This phenomenon has drawn the attention of journalists and consumer advocates because of the significant consequences of observation stays for beneficiaries’ out-of-pocket costs.

July 2012
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