Archive for the ‘health care providers’ Category

Top health industry issues of 2015

December 15, 2014 Comments off

Top health industry issues of 2015
Source: PriceWaterhouseCoopers

Issue 1: Do-it-yourself healthcare

Issue 2: Leap from mobile app to medical device

Issue 3: Balancing privacy and convenience

Issue 4: High-cost patients spark innovations

Issue 5: Putting a price on positive outcomes

Issue 6: Open everything to everyone

Issue 7: Getting to know the newly insured

Issue 8: Scope of practice expands

Issue 9: Redefining well-being for millennials

Issue 10: Partner to win

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Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker

December 15, 2014 Comments off

Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker
Source: Kaiser Family Foundation

States design and administer their own Medicaid programs within federal rules, and states and the federal government share Medicaid costs and have shared stakes in the program. One of the most important programmatic decisions that states make is how they will deliver and pay for care for Medicaid beneficiaries. Historically, states purchased services largely on a fee-for-service basis. However, since the early 1980s and particularly in recent years, states have increasingly used various models of managed care. The dominant model is comprehensive risk-based managed care, in which states contract with managed care organizations (MCOs) to provide comprehensive acute care, and in some cases long-term services and supports as well, to Medicaid beneficiaries, and pay the MCOs a fixed monthly premium or “capitation rate” on behalf of each enrollee. This model is called risk-based managed care because, through contracts, states shift the financial risk for serving their Medicaid beneficiaries to MCOs.

Today, 39 states contract with a grand total of about 265 MCOs to provide comprehensive Medicaid services; over 90% of Medicaid beneficiaries live in these 39 states. As of September 2014, more than half of all Medicaid beneficiaries nationwide were enrolled in MCOs, and the role of MCOs in Medicaid continues to grow, as an increasing number of states adopt risk-contracting programs, and states with existing programs expand them to include larger geographic areas and beneficiaries with more complex needs, shift from voluntary to mandatory enrollment in MCOs, and move long-term services and supports into capitated arrangements. In addition, states expanding Medicaid under the Affordable Care Act (ACA) are relying largely on MCOs to serve the millions of newly eligible adults. More broadly, the ACA expansions of both Medicaid and private health insurance are fueling dynamism in the managed care market as MCOs and large managed care companies position themselves to take advantage of new opportunities.

HHS OIG — Access to Care: Provider Availability in Medicaid Managed Care

December 12, 2014 Comments off

Access to Care: Provider Availability in Medicaid Managed Care
Source: U.S. Department of Health and Human Services, Office of Inspector General

Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, States can opt to expand Medicaid eligibility, and even States that have not expanded eligibility have seen increases in enrollment. Most States provide some of their Medicaid services-if not all of them-through managed care. OIG received a congressional request to evaluate the adequacy of access to care for enrollees in managed care. This report determines the extent to which providers offer appointments to enrollees and the timeliness of these appointments. A companion report issued earlier this year, State Standards for Access Care in Medicaid Managed Care, OEI-02-11-00320, found that State standards for access to care vary, and that they are often not specific to certain provider types or to areas of the State. Additionally, States have different strategies to assess compliance with access standards.

We based this study on an assessment of availability of Medicaid managed care providers. The assessment included calls to a stratified random sample of 1,800 primary care providers and specialists to assess availability and timeliness of appointments for enrollees.

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

Together, these findings-along with those from our companion report-call for CMS to work with States to improve the oversight of managed care plans. We recommend that CMS work with States to (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed. CMS concurred with all three of our recommendations.

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals

November 24, 2014 Comments off

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals
Source: Brookings Institution

A not so well-known provision of the Affordable Care Act is the Sunshine Act. The purpose of this act is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. Mandated by the Sunshine Act, on September 30th, Centers for Medicare and Medicaid Services (CMS) publicly released the first set of data, under the Open Payments title. This data includes $3.5 billion paid to over half a million doctors and teaching hospitals in the last five months of 2013.

A subset of Open Payments data that is individually identifiable includes two categories of payments. The first category are the payments that are made for other reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. These datasets together include more than 2.3 million financial transactions which amount to a total of more than $825 million.

The U.S. Health Workforce: State Profiles

November 20, 2014 Comments off

The U.S. Health Workforce: State Profiles
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration

The State Profiles provide data on 35 types of health workers – from physicians, nurses, and dentists to counselors, physical therapists, laboratory technicians, nursing assistants, and others.

They are companion documents to the U.S. Health Workforce Chartbook and were developed to make data on the U.S. health workforce more readily available to diverse users.

Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas

November 19, 2014 Comments off

Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas (PDF)
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration

Key Findings

  • Among rural residents, there are proportionately more providers in occupations that require fewer years of education and training. Among urban residents, there are proportionately more providers in occupations that require greater years of education and training.
  • Some sectors of the health care workforce have proportionately fewer providers living in rural areas, regardless of amounts of education and training.

Foreign Nurse Importation to the United States and the Supply of Native Registered Nurses

November 19, 2014 Comments off

Foreign Nurse Importation to the United States and the Supply of Native Registered Nurses (PDF)
Source: Federal Reserve Bank of Boston

Importing foreign nurses has been used as a strategy to ease nursing shortages in the United States. The effectiveness of this policy critically depends on the long-run response of native-born nurses. We examine how the immigration of foreign-born registered nurses (RNs) affects the occupational choice and long-run employment decisions of native RNs. Using a variety of empirical strategies that exploit the geographical distribution of immigrant nurses across U.S. cities, we find evidence of large displacement effects—over a 10-year period, for every foreign nurse that migrates to a city, between one and two fewer native nurses are employed in that city. We find similar results at the state level using data on individuals taking the nursing board exam—an increase in the flow of foreign nurses significantly reduces the number of natives sitting for licensure exams in the states that are more dependent on foreign-born nurses compared to those states that are less dependent on foreign nurses. Using data on self-reported workplace satisfaction among a sample of California nurses, we find evidence suggesting that some of the displacement effects could be driven by a decline in the perceived quality of the workplace environment.


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