5 Post-ACA Healthcare Trends To Watch

According to a new report by PwC, the Affordable Care Act (ACA) has had a profound impact on the healthcare industry in the last five years and will continue to do so. The report identifies five industry trends to watch:

  • The shift to value-based care.
  • A renewed focus on primary care.
  • A new emphasis on innovation.
  • A move from wholesale health insurance to retail insurance.
  • A new focus on the state’s role in healthcare form.

Click here to see the report.

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New CBO Report Lowers Its Projection For ACA Implementation Cost

Once again, the Congressional Budget Office (CBO) has lowered its projection for the cost of implementing the Affordable Care Act (ACA). In a new report, the CBO estimates the cost of health insurance subsidies, Medicaid and Children’s Health Insurance Program (CHIP) outlays and small-employer tax credits at $648 billion for 2015 to 2019. However, once the number is subtracted from the $142 billion in payments to the government due to the individual mandate, employer mandate, and Cadillac tax, the cost of ACA implementation over the same time period comes to $506 billion – a 30 percent drop from the CBO’s initial projection of $710 billion.

The report cites three key factors for the lower estimate:

  • Private insurers selling policies in the state and federal insurance exchanges that are charging lower premiums than expected.
  • A projected decrease of 2 million in the expected number of Medicaid and CHIP enrollees by 2025.
  • The historic low rate of healthcare spending growth.

Click here to see the report.

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New ACO Model May Have Positive Post-Acute Impact

Earlier today, we informed you about CMS’ new Next Generation ACO Model. According to CMS officials, the new model may be beneficial for those trying to offer the best post-acute setting for seniors, specifically for reducing hospital admissions. CMS officials say the model could have a very positive effect on the post-acute arena because it incentivizes providers to keep the person from being readmitted to the hospital. Instead, the model encourages providers to keep people in the skilled nursing facility until they are ready to go home. Furthermore, the program would let beneficiaries “enter skilled nursing care without prior hospitalization” and includes modifications “to expand the coverage of telehealth and post-discharge home services to support coordinated care at home.” These new rules would prevent beneficiaries from potentially falling into the observation stay trap, and avoid returning to the hospital after being discharged from a SNF.

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CMS Announces “Next Generation” ACO Model

Yesterday, CMS  launched a new Accountable Care Organization (ACO) initiative known as the Next Generation ACO Model. The new model “builds on the successes of earlier ACO models, such as the Pioneer ACO Model, and further enables innovation by providers to improve care for patients.” The Next Generation ACO offers new opportunities in accountable care, setting more predictable financial targets, and gives providers and beneficiaries more opportunities to coordinate care. The Next Generation ACO Model will take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings. Additionally, the new model encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries by enhancing services that beneficiaries can receive from participating ACOs.

For more information on the Next Generation ACO Model, click here.

Click here to read more from CMS.

Tiptastic Tuesday: 4 Ways To Tackle Healthcare Disparities

Significant care quality disparities due to race, income, gender, and sexual orientation continue to trouble the American healthcare system. For providers, the biggest challenge is pinpointing what to do about it. However, the Affordable Care Act, along with creative solutions at the community level have expanded coverage and care efforts. Experts offer four practices that can help in eliminating these disparities:

  1. Develop health education tools that cater to different segments of the population.
  2. Invest in translation and interpretation services for bilingual patients.
  3. Use electronic health records (EHRs) to track and measure the health outcomes of patients, and use this information to design better treatments.
  4. Partner with the community to foster outreach and care care.

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Several States No Longer Plan On Expanding Medicaid

Several states are now leaning toward or have outright abandoned all plans to allow expansion of their Medicaid programs. Most recently, Wyoming rejected plans to expand its Medicaid program via provisions offered under the Affordable Care Act. Representatives for Kansas have also told reporters that the state is not planning on scheduling hearings on three different bills allowing for Medicaid expansion. So far, 29 states have formally adopted Medicaid expansion, while the rest have either rejected adoption or are still considering it. Medicaid program enrollment has been growing exponentially under the new health law. The Obama administration announced that more than 10 million Americans have joined the Medicaid program since 2013.

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Feds Penalize Hospitals For Inflection Rates

The federal government is penalizing more than 700 hospitals across the country for having high rates of hospital acquired infections. In Connecticut, 14 hospitals are facing the penalty and consequently losing millions of dollars. The Patient Protection and Affordable Care Act includes provisions intended not only to improve access to healthcare but also to improve healthcare itself.  According to the law, hospitals that do the worst get penalized and lose one percent of their Medicare payments over the course of the year.

In Connecticut, 45 percent of hospitals in the program were penalized – among the highest rates in the nation. However, some hospitals that were penalized, including Yale-New Haven Hospital, argue that the federal government’s specific data set has problems. Yale’s leaders believe that hospitals like theirs have improved and that the data does not take important factors, such as hospitals with higher rates of less healthy patients, into account. However, unless lawmakers decide to strip the provision in the health law, the penalty will remain and come back again next year.

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