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CMS controls 50% of the healthcare payer market in the US. Many provider networks are failing due to economic factors and changes in technology. The Affordable Care Act (ACA) has also contributed to disruption, though it was not mature enough to achieve its long-term goals. Moving forward, integrated healthcare systems involving public-private partnerships between payers, providers, and technology companies will be necessary to sustain the system and maintain access to care.
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Change the patient encounter environment.
Augment standard approaches with technology.
Manage patient access and flow through the healthcare system.
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Physician leadership and accountability.
Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings ...
The document summarizes a presentation about how the shift to value-based care and revisions to the Medicare Shared Savings Program (MSSP) represent the next revolution in healthcare. It discusses how MSSP revisions will require accountable care organizations (ACOs) to take on more financial risk earlier. It argues that health systems that effectively use data to improve quality and lower costs will succeed under these changes. The document provides an overview of the MSSP and strategies that ACOs can use to succeed under the new requirements, including leveraging technology, predictive analytics, and shifting routine care management away from physicians.
With so much anticipated change forthcoming in healthcare policy, this outloo...
The document summarizes a breakfast forum discussing how changes to US healthcare policy will affect businesses. Experts Don Gilbert, Jim Springfield, and Dr. Kelly Larkin discussed the impact of repealing and replacing the Affordable Care Act. If no changes are made, the national healthcare system could deteriorate as healthier individuals opt out, leaving a sicker risk pool. Attorneys note businesses will likely see increased healthcare costs passed down from federal government cuts to states to providers. While the future is uncertain, most agree Congress will pass a bill this year reducing some regulations.
5 wk HCS440 Legislations Influence in Health Care & what Changes final
The document discusses various pieces of health care legislation and their influence on the U.S. health care system. It addresses the Welfare Reform Act of 1996, the Health Insurance Portability and Accountability Act (HIPAA), and the Affordable Care Act of 2010. It also examines tools from the Centers for Disease Control and Prevention for analyzing economic impacts. Finally, it proposes some potential changes that could be made to legislation to help combat rising health care costs and make the Affordable Care Act more affordable.
Arkansas Medical News Interviews Dr. Marcinko
The document discusses how the economic recession is negatively impacting hospitals through decreased admissions and procedures, while costs are rising. It recommends that hospitals improve management of revenue cycles, supply chains, and scheduling to cut costs. The federal stimulus package will provide funds to states that can help hospitals through higher Medicaid matching rates and grants for health IT. However, the full impact will depend on restrictions from Medicare/Medicaid on the use of funds.
Achieving Stakeholder Engagement: A Population Health Management Imperative
The document discusses achieving stakeholder engagement in population health management. It states that to improve care in a value-based market, health systems must become competent in PHM but it can be complicated by organizational barriers. It argues that to succeed, health systems need multidisciplinary support across the organization and that earning stakeholder backing relies on real-time, actionable data and analytics to measure effectiveness of improvements.
May
Mr. Wojcik provides a newsletter update for his clients on various healthcare topics. He explains that he took a break from newsletters to avoid spreading misinformation during the uncertain healthcare reform period. The newsletter includes sections on "Know Your Employee Benefits" tips, healthcare cost analytics, compliance updates, wellness program trends, and industry news. It aims to help clients control costs, workload, and anxiety around benefits.
Comments on Affordable Care Act and other healthcare issues
CardiacAssist is a medical device company based in Pittsburgh that manufactures the TandemHeart circulatory assistance device. In a presentation to the White House Business Council Roundtable, the company's CFO discussed several concerns with the Affordable Care Act including the medical device tax, volatile healthcare insurance premiums, and provisions that may promote age and family discrimination in hiring. The CFO also expressed concerns about overregulation by the FDA and CMS, the need to address addiction and obesity issues, and a desire for less government control over the healthcare system and insurance marketplace.
Michael Jackson Intel Q&A HIMSS15_post
Michael Jackson has over 15 years of experience helping organizations grow new markets as the general manager of Intel's Consumer Health division. A perfect storm of factors is fueling significant growth in the consumer health segment, including payment reform prioritizing outcomes over services, increased consumer empowerment and engagement, and demand in emerging markets. However, realizing the full potential of consumer health faces challenges regarding stakeholder alignment, balancing data privacy and interoperability, and ensuring inclusion of providers and underserved groups.
From the Desk of Mike Wojcik May Newsletter
The document is a newsletter from The Horton Group providing updates on healthcare reform and employee benefits topics. It includes summaries of reports on rising healthcare costs, reasons for high US healthcare spending compared to other countries, and a study finding that over half of individual health plans would not meet requirements under the Affordable Care Act. It also lists upcoming topics to be covered in future issues such as prescription drug trends, worksite wellness initiatives, industry news, and notification of upcoming workshops. The newsletter seeks to help clients reduce costs and complexity in healthcare.
Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies
Healthcare leaders are eager for a modicum of clarity when it comes to the industry’s shift to value-based healthcare given the uncertainties of Congress and the new Administration.
Fortunately, an analysis of three key pieces of information tells us value-based healthcare is likely here to stay:
The 21st Century Cures Act (Cures).
The Executive Order on reducing the “burden” of the Affordable Care Act (ACA).
Tom Price’s comments at his confirmation hearings.
It is a relatively safe bet that value-based healthcare delivery and payment programs will continue to be supported by federal law and regulation for several reasons:
Bipartisan support: The success of Cures indicates that bipartisan cooperation will continue on key healthcare issues.
Market-based innovation: The emerging evidence is that Congress and the Administration will support innovation in payment and delivery models.
Support for Existing ACA Innovation programs: Although highly uncertain, there are some indications that not all of the ACA will be scrapped.
RUNNING HEAD Affordable Care Act .docx
RUNNING HEAD: Affordable Care Act 1
Affordable Care Act 2
ACA Healthcare Policy
Busola Omolayole
Walden University
TN006 Policy and Regulation Supporting Informatics and Technology Integration
2/3/2020
Affordable Care Act (ACA)
The affordable care act (ACA) policy was signed into law by the previous U.S. President Barack Obama in March of 2010 (HealthIT.gov., n.d.). The policy shares the responsibility of providing access to reasonable and good-quality health insurance by the government to individuals, employers in the United States. It is aimed at improving access and expanding health insurance coverage to all U.S. citizens and combat healthcare spending and costs (Quadagno, 2019). Also, the policy increased accessibility to care and quality care services, which determine the overall health in the U.S. Health insurance companies cannot deny coverage of preexisting conditions and cannot increase premiums based on medical conditions.
Impact of the ACA on System Implementation
After the 2016 open enrollment period, 17.6 million uninsured citizens obtained coverage through ACA; the uninsured rate fell below 10 percent that same year. (U.S. Department of Health & Human Services, n.d.). ACA has a significant impact on system implementation, according to industry experts. ACA supports Medicaid expansion. Make healthcare coverage more affordable and fair. The establishment of new health insurance marketplaces, also known as exchanges and implementation of market reforms, is another issue that is being addressed (HealthIT.gov.,n.d.). Providing care for people who live on a limited income or have a preexisting condition. Strengthening access to preventive and primary care. Increase healthcare quality at the same time decreasing careless expenses and increasing being accountable (PolicyMedical., n.d.). ACA has provisions that give system implementation a motive to build and enforce new policies that target increased efficiency (Ruffin, 2019). ACA is poised for consistent growth through value-based medications in the presence of evident uncertainty with a gradual repeal of the ACA for many payers in the care sector. Through growth in clinical care and public programs, being strategical in investments in public health (PolicyMedical., n.d.). By collaboration amongst the government, individuals, and employers, Americans can attain universal healthcare.
ACA has Improved Outcomes and Efficiencies
ACA has increased care coverage to millions of U.S. citizens. As a result, there is an improvement in care quality services since the healthcare cost is subsidized. Those with health insurance access better services in the United States (Huang et al., 2019). The wide range of plans resulting from ACA increases efficiency ...
RUNNING HEAD Affordable Care Act .docx
RUNNING HEAD: Affordable Care Act 1
Affordable Care Act 2
ACA Healthcare Policy
Busola Omolayole
Walden University
TN006 Policy and Regulation Supporting Informatics and Technology Integration
2/3/2020
Affordable Care Act (ACA)
The affordable care act (ACA) policy was signed into law by the previous U.S. President Barack Obama in March of 2010 (HealthIT.gov., n.d.). The policy shares the responsibility of providing access to reasonable and good-quality health insurance by the government to individuals, employers in the United States. It is aimed at improving access and expanding health insurance coverage to all U.S. citizens and combat healthcare spending and costs (Quadagno, 2019). Also, the policy increased accessibility to care and quality care services, which determine the overall health in the U.S. Health insurance companies cannot deny coverage of preexisting conditions and cannot increase premiums based on medical conditions.
Impact of the ACA on System Implementation
After the 2016 open enrollment period, 17.6 million uninsured citizens obtained coverage through ACA; the uninsured rate fell below 10 percent that same year. (U.S. Department of Health & Human Services, n.d.). ACA has a significant impact on system implementation, according to industry experts. ACA supports Medicaid expansion. Make healthcare coverage more affordable and fair. The establishment of new health insurance marketplaces, also known as exchanges and implementation of market reforms, is another issue that is being addressed (HealthIT.gov.,n.d.). Providing care for people who live on a limited income or have a preexisting condition. Strengthening access to preventive and primary care. Increase healthcare quality at the same time decreasing careless expenses and increasing being accountable (PolicyMedical., n.d.). ACA has provisions that give system implementation a motive to build and enforce new policies that target increased efficiency (Ruffin, 2019). ACA is poised for consistent growth through value-based medications in the presence of evident uncertainty with a gradual repeal of the ACA for many payers in the care sector. Through growth in clinical care and public programs, being strategical in investments in public health (PolicyMedical., n.d.). By collaboration amongst the government, individuals, and employers, Americans can attain universal healthcare.
ACA has Improved Outcomes and Efficiencies
ACA has increased care coverage to millions of U.S. citizens. As a result, there is an improvement in care quality services since the healthcare cost is subsidized. Those with health insurance access better services in the United States (Huang et al., 2019). The wide range of plans resulting from ACA increases efficiency .
Garwood _ HealthCare Vendor Finance
The document discusses several key trends in the U.S. healthcare system: 1) Healthcare spending in the U.S. is the highest in the world at 16.4% of GDP but results in low quality of care rankings; 2) In response, the system is focusing on controlling costs and improving quality which has led to consolidation of hospitals and physician practices; 3) This has shifted medical equipment purchasing decisions from doctors to healthcare executives focused on total cost of ownership. Equipment financiers must address both clinical and financial concerns to help vendors navigate this changing landscape.
Mercer Capital's Value Focus: Healthcare Facilities | Mid-Year 2016 |
Mercer Capital's Healthcare Facilities Industry newsletter provides perspective on valuation issues. Each newsletter also includes macroeconomic trends, industry trends, and guideline public company metrics.
J_Wojcikowski_TeamB_HCA_Healthcare_Industry_Labor_Employment_Analysis_Researc...
This document is a research paper analyzing employment and labor trends affecting Hospital Corporation of America (HCA) and the healthcare industry. It provides an overview of the healthcare industry and compares its growth to other industries. It also describes HCA, the largest for-profit healthcare company, and analyzes its employment data. The paper examines recent employment and unemployment trends in healthcare and how government regulations like the Affordable Care Act have impacted demand for healthcare workers.
Intensive Care for Medicaid McQ Quarterly 2005
This document summarizes a McKinsey report analyzing the unsustainable growth of Medicaid costs in the United States. It finds that by 2009, Medicaid will consume more than 75% of new state revenue in some states and 25-50% in many others. While opportunities exist to capture savings, actually doing so will require difficult decisions and creative leadership given political and structural challenges. Reform is needed to put Medicaid on a more stable long-term footing while still serving those in need.
Healthcare Reform and 21st Century Healthcare Information Systems.docx
The document discusses several initiatives associated with healthcare reform and their implications for 21st century healthcare information systems. It analyzes initiatives like telemedicine, patient portals, and bundled payment techniques. It evaluates the challenges of each initiative, such as high costs and limited resources. It also assesses the impact of the initiatives on leadership, strategic planning, and enterprise systems. Finally, it predicts increasing adoption of major standards and health information management systems over the next five years.
Future of healthcare 15 october 2019
Further to several additional expert workshops this year, we are delighted to share an updated global perspective on the future of healthcare. Produced in partnership with Duke Corporate Education (http://www.dukece.com), this adds new insights on the pivotal shifts taking place across the sector plus viewpoints on some of the core implications for leadership. Topics include the growing power of data; the rising impact of urbanisation on health; increasing patient centricity; the need for more flexible organisations and the move of innovation activity eastwards.
Available as both a report and as this accompanying presentation this is now being used to inform and provoke further debate around the world. As ever we would like to thank all those who have given their time and insight to contribute to this project.
Similar to CMS controls 50 % (20)
From Volume to Value: 10 Essential Strategies for Navigating the Healthcare S...
From Volume to Value: 10 Essential Strategies for Navigating the Healthcare S...
Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings ...
Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings ...
With so much anticipated change forthcoming in healthcare policy, this outloo...
With so much anticipated change forthcoming in healthcare policy, this outloo...
5 wk HCS440 Legislations Influence in Health Care & what Changes final
5 wk HCS440 Legislations Influence in Health Care & what Changes final
Achieving Stakeholder Engagement: A Population Health Management Imperative
Achieving Stakeholder Engagement: A Population Health Management Imperative
Comments on Affordable Care Act and other healthcare issues
Comments on Affordable Care Act and other healthcare issues
Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies
Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies
Mercer Capital's Value Focus: Healthcare Facilities | Mid-Year 2016 |
Mercer Capital's Value Focus: Healthcare Facilities | Mid-Year 2016 |
J_Wojcikowski_TeamB_HCA_Healthcare_Industry_Labor_Employment_Analysis_Researc...
J_Wojcikowski_TeamB_HCA_Healthcare_Industry_Labor_Employment_Analysis_Researc...
Healthcare Reform and 21st Century Healthcare Information Systems.docx
Healthcare Reform and 21st Century Healthcare Information Systems.docx
CMS controls 50 %
- 1. October 31, 2016: Healthcare Integration within the United States by Gary Stanford CMS controls50% of Payerbusiness. Contractionsof providersare uponusunfortunately here inthe UnitedStates. A countrywhere billionsof dollarswereinvestedinthe 60’sand 70’s to launchforprofit healthcentersthroughoutthe country toprovide healthcare servicesare now becomingbankrupt. Today,many providernetworksare failingfor numerousreasons. These massive changes inour landscape of healthcare are broughtonby “in fact” bythe many breakthroughof technology,whether by productor service. Many analysistwill pointtoeconomicvariance withinthe countrytomismanagementof those large IDN’swhohave causedthisdisruption. Orlook to blame the impactonthe shortlivedACA program as one of the mainchallengesto ourhealthcare system. Frankly,the lackof maturity of ACA, supporting the program isa longtermplan. It has not hada chance to grow teethtoday. The ACA neededtime tomature the groupsof uninsuredintoourhealthcare privatizationefforts. MedicaidandPrivate payare inherentlydifferent. The neteffectfromthe lossesrealizedof the ACA and manyothergovernmentprograms hasonly spedupthe process of our healthcare disasterwe are experiencingnow. From a financial perspective,thereare still waystobe profitable. Manybreak-evenformulasto achievingprofitable modelsare availableinmostmarkets. Theywill relyonthe economicenvironment, providerAtRisk,(+-) available integratedservicesinacommunity(bundled). WHYdidMedicare Advantage andManage Care Medicaidlaunchinthe firstplace?(Rhetorical) Governmenthasnot alwaysproventobe the bestcourse of action withdeliveringhealthcare. Mainlythe role isactingas the conduitforcollectingdollarsforthe programssetforthby ourcongress,as a verylarge billing department. Today,providersare at a crossroad withCMS reimbursementand"AtRisk"models. The autonomyin the marketswhere providerslive andwork are at jeopardy,right? FACT: Medicaidexpansionwillcontinueandsowill the populationof Medicare recipients“baby boomers”. From andadministrationperspective... relatedtothe new lawswithALRforadoptionwitha Health Plan. Today's healthcare climate an"atrisk"Payeris notsustainable. Complianceof ALRwasa good ideaconceptuallytargetingPayer,doesnothelpthe existingmodelsandrelatedvendorsupport,as plannedbyACA. TPAswithoutCare Managementhave limitedimpactonALR/MLR reform.Claimruns (reports) RULE the business,bottomline. ALRfallsinline (period) regardlessof PayerandorTPA. Thisis not the mainchallenge withhealthcare reform. Yes,payersmade alot of moneyoverthe yearswith managingadministration;itwasgoodto make some of these changesgoingforwardinour country. Netresults of an enhancedandimprovedhealthcare delivery will be fromthe partnershipsformedin the "like"variedAtRiskhealthplanoptions. These willbe negotiatedand soonwill be the normwithin our healthcare deliverysystem. A more robustintegratedhealthcare ladensystemwithsolutionswillbe
- 2. October 31, 2016: Healthcare Integration within the United States by Gary Stanford the mainstreaminourhealthcare ecosystem. These toolswill helpmaintainsustainabilityinyour market. It will notmatterwhetheryouare Medicaid,Medicare,GovernmenttoPrivate Pay,the integrationof healthcare serviceswill be provide throughanintegral mix of servicesandproductsfrom technology. The backbone of healthcare are and will continue be availablethroughthose toolsdevelopedand adoptedwithinanPayer,Provider,Pharmaintothe Technology availablethroughthe cloud, andor remote Retail centerswhomwill offerendtoendsolutionsviaaformof CommunityHealthNetworkor enterprise developedwithinaregion. Here are some perspectiveongroupswhohave beennegativelyimpactedfromACA andCMS. As well as opportunitiesfromneededandavailable technologytomodelswhere ProviderandPayersare not integratingforthe benefitof helpingsupportthe healthof membersandpatientstheyserve and support. - Payersblocksof business.Blocksof businessw/traditional Payersare exiting. - Provider(networks),doingmore withless. Meaningful Use wasa startingpointforsome. - Employergroupsinvestmentw/at-riskinvestmentinHMO "like"evencooperative ACO relatedtothe (their) communityhealthnetwork. - ACO'sare a bridge to...socialize medicine. Mostwinninghealthcare systemshave theirown performance standardstheyadoptedmanyyearsago. Thisisnot new,the new reimbursements models byourlargestpayer(CMS) iswhatis new. IDN'sto Primarywho will developandsupportan"AtRisk"model individually. Eachwill have along term(shared) riskinvestmentstrategiesgiventheirrespective targets,brandof,& reimbursementfrom CMS and the balance / population. Thisisour healthcare reformfortomorrow. At Newco,we will provide consultingtosupportingapartnershiptohelpstudyany(initial) impact(+/ -) financial study whichidentifies you’reatrisk portion,plusthe versionof the sharedinterestof our businessmodel,andnecessarywhat returnof investment realized. Inquiriesplease contact: Gary Stanford Office: (615) 430-4393 Email: bbm09@comcast.net