Latest California Healthline Stories
New Cost Tool Aims To Boost Pay-for-Performance Model of Care
In an effort to measure value in health care transactions, the Integrated Healthcare Association is introducing a “Total Cost of Care” metric to be used in its pay-for-performance program. IHA hopes the new tool will speed up improvements in clinical quality by providing financial incentives to physicians.
Austerity Won’t Help Physician Shortage, Experts Predict
Cutbacks in Medicare and Medicaid could make it more difficult to deal with a physician shortage in California that threatens to become more severe as millions of newly insured people join the reformed health care system. California groups are lobbying to streamline and subsidize the training of new primary care doctors.
Medicare ACOs a Boon to Senior Care in State?
Don Crane is pretty happy. He’s president and CEO of the California Association of Physician Groups, and he’s been waiting for quite some time for federal officials to finalize the rules governing establishment of Medicare accountable care organizations.
The final regulations announced by CMS could be big news for California, Crane said.
“I think this is going to have a huge impact on the California health care landscape,” Crane said. “What this means is significantly more penetration of ACOs in the senior market.”
When a Law Loses Its Teeth, Can the Reform Still Bite?
After months of industry criticism, CMS’ accountable care organizations are winning plaudits after the agency made the program less intimidating for participants. Some suggest that will make ACOs less effective tools of reform, too.
State Laying Foundation for Duals Conversion
The state’s Department of Health Care Services released a series of draft papers this week, outlining some of the concerns and aims of its planned conversion program, which will eventually offer managed care choices to dual eligibles — those Californians who are eligible to receive both Medi-Cal and Medicare benefits.
The latest paper, released yesterday and expected to be posted on the DHCS website today, looks at the possible scope of that transition and finds it could include many more than the 150,000 people originally estimated for the conversion program.
“There are 370,000 duals in Los Angeles County alone,” according to Peter Harbage of Harbage Consulting, who worked on the papers. “There are another 250,000 in the next four largest counties. The paper opens the conversation on that point, as well as on other key issues.”
The Benefits of Changing Medicare’s Drug Benefit
Medicare Part D is Exhibit A in how a health reform can evolve from partisan legislation to beloved protection. Aware of the drug benefit’s popularity, but facing real fiscal concerns, lawmakers are broaching delicate changes to the program.
Quality Ratings Offered in Medicare Enrollment Window
Open enrollment for Medicare starts at the end of next week. This week, the federal government launched its online service to help people make Medicare decisions. This year, ther service offers a little something extra, according to David Sayen, the regional administrator for CMS.
“This enrollment period is different,” Sayen said. “For the first time, we’re rewarding quality.”
Medicare Advantage plans now will be rated for quality of care. Part D prescription drug plans will continue to be rated for quality.
Pitfalls and Promise of Converting California’s Dual Eligibles
The state would like to move “dual eligibles” — Californians who receive both Medicare and Medi-Cal benefits — into managed care plans. State officials say the move would save money and improve care, but it’s a big and complicated task.
Reform’s Unanswered Question: To Trim or Transform Medicare?
More cuts to Medicare are looming, just months after the Affordable Care Act sliced billions in program spending. Whether the new changes will be sweeping or merely substantive remains to be seen.
Accounting for the ACO Backlash by Recounting DRG Fight
All kinds of health care stakeholders seem to agree: CMS’ proposed ACOs are profoundly disagreeable. But is this criticism truly new or just providers’ traditional resistance to federal efforts to overhaul health care payment?