According to a new study by the Urban Institute, healthcare costs will continue to remain low in years to come, “with the Affordable Care Act playing some yet-to-be fully defined role.” Between 2014 and 2019, CMS projects $2.5 trillion less in public and private healthcare spending compared to projections made earlier by the agency. Over the 2014-2019 period, Medicare spending is expected to decrease by $384 billion, Medicaid by $927 billion, and private health insurance by $688 billion compared to the September 2010 ACA baseline. Originally, the baseline projected spending will total $23 trillion between 2010 and 2019. CMS now says it’s at $21 trillion. The report credits the ACA and new legislation for the trend.
Increased levels of patient engagement through patient activation may improve outcomes and lower healthcare costs, according to a new study published in Health Affairs. Researchers analyzed patient activation levels for more than 32,000 adult patients at Minnesota’s Fairview Health Services under the Patient Activation Measure, a “metric used to quantify a person’s knowledge, skills, and confidence in managing one’s own health and healthcare” on a scale of one to four. Researchers found patients with higher levels of activation demonstrated nine out of 13 improved healthcare outcomes. Lower activation levels were associated with significantly reduced chances of positive outcomes for seven of 13 measures compared to patients who remained at level four. The research team also found activation had similar effects on billed costs. Patients with the highest levels of activation had projected costs 31 percent lower than those at the lowest activation levels. Additionally, costs increased or decreased as patients’ activation levels changed.
According to a new report from The Commonwealth Fund, increased insurance coverage under the Affordable Care Act is unlikely to overwhelm healthcare services despite earlier research indicating the contrary. The report found that outpatient and inpatient hospital visits will increase by about 2.5 and 3 percent nationwide and that prescription medication use and refills will rise 2.5 percent in nearly every state. Despite these increases, the healthcare system is “likely to be able to absorb these increases.” Additionally, widespread adoption of technological advances is likely to further blunt the impact of increased use of services.
Earlier this week, the U.S. Department of Health and Human Services (HHS) announced that it was planning on fundamentally changing the way it pays providers for treating Medicare patients. The primary intent is to cut down on the volume of duplicative procedures while improving care coordination and patient outcomes. For the first time, HHS is “setting clear goals–and establishing a clear timeline–for moving from volume to value in Medicare payments” and “will use benchmarks and metrics” to measure progress.
Following this announcement, Patrick Conway, M.D., deputy administrator for innovation and quality and the chief medical officer at CMS, said the agency will tie 30 percent of all fee-for-service provider payments to quality initiatives through alternative payment models, particularly ACOs and bundled payments by 2016. This number will increase to 50 percent by 2018. Currently, about 20 percent of Medicare FFS payments are through new payment models. CMS intends to accelerate the program through expansion of current payment models, such as Pioneer and ACO programs, as well as emerging models, including bundled payments for oncology care.
The U.S. health system is currently coping with a rapidly growing aging population. In lieu of this, researchers are looking at hospital discharge data to better understand how older Americans navigate the healthcare system, and when they are the most in need of long-term care. According to a new report by the National Center of Health Statistics released earlier this week, people age 85 and older made up nearly 10 percent of all hospital discharges in 2010 despite accounting for just 2 percent of the population. People in the 85 or older age group are also significantly less likely to go home once they are discharged from the hospital, commonly being admitted into nursing homes at a higher rate than people even 10 years younger. Complications, including the common hip fracture (usually the result of falling), is the primary reason why people in this age group needed to go to the hospital in the first place. For people age 85 and older, hip fractures are nearly three times higher than people just one decade younger. Researchers note that going forward, a growing percentage of our population will be in the 85-and-older age group.
Consumers can visit HealthCare.gov to review detailed information about all the health insurance plans offered in their area before applying ahead of open enrollment on November 15. This year, consumers will find more affordable options for themselves and their families due to more insurers offering coverage through the Health Insurance Marketplace. After answering a few simple questions, consumers will be able to compare plans and get an estimate on how much financial assistance they may qualify for when shopping for coverage without submitting an application.
Open Enrollment for the Health Insurance Marketplace begins Saturday, November 15, 2014 and runs through Sunday, February 15, 2015.
Innovation is a major theme in the healthcare industry today. According to speakers at a Women Who Inspire discussion sponsored by Northeastern University, business innovation doesn’t just happen. Organizations need to have the right professional environment to encourage and nurture innovation.
Empower employees. Give your employees the power to problem-solve and innovate by creating a culture where they feel comfortable taking risks. Provide the necessary resources to educate and empower them.
Take calculated risks. Provide your employees with tools to help them explore possible scenarios and develop plans with confidence.
Hire a diverse team. Seek employees who have demonstrated creativity in previous positions and don’t work the same way you do.
In the U.S., it’s still nearly impossible to compare the price and quality of anything in healthcare. Recently, websites that mine data have been popping up all over the web to fill the void and reveal prices for everything-from an office visit to a cesarean section. In Massachusetts, a new law has forced health insurance companies to increase transparency by making all their prices public in advance. These online tools calculate the patient’s cost based on his or her plan. For instance, in Boston, the prices for an MRI range from $641 to $1,800. Most people don’t have a strong incentive to shop because the co-pay is typically the same no matter where one goes. However, with increasing deductibles, where patients pay the full cost of an office visit or test up to the amount of their deductible, it’s becoming more and more relevant.
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