Health Care Consolidation

In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This toolkit explores the driving forces behind this trend; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.

Telemedicine Toolkit: The Promise and Challenges

The integration of technology and health care is on the rise. Although evidence shows that telemedicine has improved access to health care and resulted in lower costs in rural and underserved areas, challenges to expansion include reimbursement policies and acceptable security measures. A new Alliance for Health Reform Toolkit, “Telemedicine: The Promise and Challenges,” addresses the effectiveness of telemedicine as a tool for communication, as well as the expected outcomes and challenges ahead.

Improving Health Care Delivery: Innovation in the Private and Public Sectors

This event examined innovative efforts in both the private and public sectors to move toward a health system that is more patient-centered, cost-efficient and delivers better outcomes. It will address efforts underway at the Center for Medicare and Medicaid Innovation (CMMI) and other federal agencies to spur innovation and prioritize a shift toward higher quality care, as well as the progress made by the private sector in improving quality and reducing costs through innovation.

Health Care Costs: What You Need to Know

The briefing explored the trends in health care costs in both the public and private sectors. It explained recent moderate growth rates, along with possible reasons and prospects for the future. This session was especially helpful to congressional staff members new to the issue, but also served as a useful review for anyone working on health care policy.

Incentives 2.0: Is Paying for Performance Enough?

Every day, health care professionals make complex decisions that directly affect the cost and quality of care. Increasingly, both private and public payers are implementing payment reforms to motivate quality improvement, reward providers for delivering high quality care, and, in some cases, impose penalties for sub-par performance, while bipartisan policy proposals to reform Medicare physician payment would modify existing provider incentive programs.

Network Adequacy: Seeking Balance

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Network Adequacy Briefing for Reporters

Network adequacy experts will meet with reporters Wednesday, August 6 to provide the latest on the subject, including details about model regulations that the National Association of Insurance Commissioners plans to release in November.

Disclosure and Apology: A Win-Win for Patient Safety and Medical Liability?

Policymakers, providers, and stakeholders have been debating various approaches to reforming our medical liability system to both protect patients who experience adverse medical events and to help practitioners provide the highest quality care possible. One innovative approach may well avoid some of the sharper policy differences on proposals in this area: encouraging the disclosure of unanticipated outcomes to affected patients. This disclosure may include an explanation and apology to the patient and family, as well as an offer of compensation in some cases. Some anecdotal data suggest that such communication-and-resolution programs can result in improved patient safety and decreased malpractice claims. However, questions arise about how well this approach really works, and whether it can be standardized and scaled up in our medical system.

Network Adequacy: Balancing Cost, Access and Quality

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Patient-Centered Medical Homes: The Promise and The Reality

While the Patient-Centered Medical Home (PCMH) model has increasingly been embraced by providers and payers as a way to improve health care and lower costs, many questions remain about its effectiveness. Definitions of medical homes vary, but they are generally known as a model that aims to transform primary care through increased coordination and communication among a team of providers. Recent medical home initiatives have encouraged primary care practices to invest in capabilities such as patient registries and electronic health records, and to achieve medical home recognition. Health plans offer to pay more to the practices that achieve recognition.

Beyond the SGR: Alternative Models

Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services.

Healthier and Wealthier, or Sicker and Poorer? Prospects for Medicare Beneficiaries Now and in the Future

Although Medicare reform is not currently a front-burner issue, proposals to reduce Medicare spending appear regularly on the policy agenda. Various Medicare savings proposals have recently emerged in the context of efforts to control the national deficit and debt, and could arise in the next few months when Congress considers how to modify Medicare’s physician payment policy to avoid a precipitous reduction in physician fees. The recently passed bipartisan budget deal delayed a reduction in Medicare payments to physicians until April, and any effort to permanently replace the existing system by which Medicare pays physicians will be costly.

Reference Pricing: Will Price Caps Help Contain Healthcare Costs?

Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge.

Quality Care: Getting More Bang for the Buck?

Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds.