MEDICAID: Putting It Into Perspective

61761844 - medicaid word cloud concept

Medicaid is in the news every day. People, politicians, policymakers, providers, and payers are expressing points of view ranging from kill it to expand it. Unfortunately, most people are not well informed about what Medicaid is. I would like to help on the informing part of the issue by describing what it is, how it works, who qualifies, how much it costs, and some policy choices I see. This is a very complex subject, so I will lay it out in bite-sized posts. Consider this first post as a backgrounder. If you want to dig deep into the subject, I recommend visiting The Center on Budget and Policy Priorities.
Read More ...

Cost Eats Revenue for Breakfast In the New Value-Based Care (VBC) Payment Landscape

magnifying-glass-1001506_640The payment landscape is shifting dramatically in the US health care industry and this has serious implications for the survival of providers. With the volume-to-value transformation, traditional fee-for-service payments are being replaced with a financial incentive framework that rewards for improved quality and outcomes. Although this impacts only Medicare payments today, it lays the groundwork and provides strong incentives for other payers to move in the same direction, thus potentially disrupting the health care system at all levels.

Ultimately, value-based payments transform traditional business models by putting significant revenue– and risk– at stake. Building the outcomes-based financial models to maximize value-based care (VBC) reimbursement pathways will be fundamental to sustainable growth in the future.
Read More ...

A New Prescription for Healthcare: Creativity, Innovation and Entrepreneurship

health-2082630_1280We are living through what is arguably the most challenging time for the health care industry. Globally, health care appears to be on a collision course with patient needs and economic reality. No one is happy with the current system, and the combination of rising costs, poor access, inequitable care, and diminishing quality and safety has created anxiety and frustration for all. Decades of interventions have failed to improve the situation; if anything, things have become worse. Current approaches tend to focus on a single issue or problem (the price of drugs, rising numbers without medical insurance, provider incentives to over treat), but an overarching solution has remained elusive.
Read More ...

Trumping Obamacare . . . How a Market Based Approach to Universal Healthcare can Work

US Medical care illustrated by flag and stethoscope

There is no issue more important to the future of America than it’s long-term fiscal sustainability. And the long-term fiscal sustainability of the United States has been placed in jeopardy primarily by the structure and expense of America’s healthcare system. According to the Congressional Budget Office, nearly the entirety of the growth in federal spending as a share of the economy—excluding interest—can be explained by government health programs: Medicare, Medicaid, the Medicaid-related Children’s Health Insurance Program, and the Affordable Care Act. In addition, one of the principal economic challenges faced by middle- and lower-income Americans is the expense and instability of American health insurance.
Read More ...

Trumping Obamacare…Decoding the American Health Care Act

American Health Care Act

After a seven year wait to repeal and replace President Barack Obama’s signature health care law, the GOP’s much-anticipated replacement collectively called the American Health Care Act (AHCA) was unveiled this week. Amidst a revolt from the left and right, doctors, hospitals and insurers, the plan cleared its first hurdle at 4.30 am on Thursday- approval by the House Ways and Means Committee and The House Energy and Commerce Committee after 18 and 27 of hours of debate respectively. It now has to be approved by a full House and the Senate…the former likely (although not guaranteed) and the latter impossible without bipartisan support.
Read More ...