10 Characteristics the differentiate the US Health Care System 1. No central agency governs a system 2. Access is selective based on insurance 3.
|
|
- Abel Davidson
- 6 years ago
- Views:
Transcription
1 10 Characteristics the differentiate the US Health Care System 1. No central agency governs a system 2. Access is selective based on insurance 3. Health care offered under imperfect market activity 4. 3 rd party insurers are intermediaries between finance and delivery 5. Multiple payers are cumbersome 6. Balance of power, no domination 7. Legal risk affects practice behavior 8. New technology creates demand for its use 9. New service settings along a continuum (primary, preventive, long-term, acute, etc.) 10. Quality is achievable
2 Moral Hazard: use of health care services to a greater extent with insurance coverage compared to no insurance coverage National Health Insurance: (Canada) financed through taxes, delivered via private providers National Health System: (UK) financed and delivered via the government (providers employed by the government Socialized Health Insurance: (Germany) financed through government-mandated contributions (that money goes to private, NFP insurance companies), delivered by private providers Health is not just the absence of disease Theories of Equitable Distribution: Market Justice (the economic good) based on willingness and ability to pay Social Justice (a social good) central agency is responsible, collectively financed and universally available Prevention: 1. Primary prevent the disease 2. Secondary early detection and treatment of disease 3. Tertiary - rehabilitation Maldistribution: a shortage/surplus of physician types needed to maintain the health status of the population 1. Geographic (shortages outside of metropolitan areas (<50k) 2. Specialty(imbalance between primary and specialty care (59.2% are specialists) Projected health care expenditure:
3 Quad Function Model with cost control measures: Rand Health Insurance Experiment: Individuals randomized to health plans with different co-insurance levels Overall, those with lower co-insurance used more health care (Moral Hazard, Elastic Demand for health care) Manning, W. G., Newhouse, J. P., Duan, N., Keeler, E. B., & Leibowitz, A. (1987). Health insurance and the demand for medical care: evidence from a randomized experiment. The American economic review, Cost, Quality, Access *Coppola et al., in Kongstvedt, 2007
4 Reasons for cost escalation: 3 rd party payment, imperfect market, growth of technology, increase in elderly population, medical model (treatment, not prevention), multi-payer system (admin costs), defensive medicine, waste/abuse, practice variations Cost-shifting: the ability of providers to make up for lost revenues in one area by increasing utilization or charging higher prices in areas free of controls Health planning: (supply-side contracts), an example is Certificate of Need (CON) legislation Demand-side incentives: ex. Cost-sharing by patients Supply-side regulations: ex. Anti-trust provisions that prohibit price fixing, price discrimination
5 Access to Care: the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner (Framework is Andersen & Newman: predisposing, enabling, need) Quality of Care: there is no common consensus among patients, providers, and payers on what quality is. Donabedian Model: Accountable Care Organizations (ACO) Financial incentives for doctors, hospitals, and other health care providers to work together to coordinate care for Medicare beneficiaries (must take responsibility for 5000 patients * 3 years) Triple Aim: Quadruple Aim:
6 Health Policy: *Longest, B. B. (2010). Health Policymaking in the United States (Fifth Ed). Health Admin Press: Chicaco, IL Health policies can be made outside of government ex. Coverage decisions made by insurance companies. Principal features of US health policy: 1. Government as subsidiary to the private sector 2. Fragmented, incremental, and piecemeal reform 3. Pluralistic and interest group politics 4. Decentralized role of the States 5. Impact of presidential leadership Attribution: All information adapted from course slides, available on BlackBoard on 28 APR 2015.
Chapter 1: A Distinctive System of Health Care Delivery
Multiple Choice Questions Delivering Health Care in America, Sixth Edition Chapter 1: A Distinctive System of Health Care Delivery 1. The primary objectives of a healthcare system include all of the following
More informationMoral Hazard Lecture notes
Moral Hazard Lecture notes Key issue: how much does the price consumers pay affect spending on health care? How big is the moral hazard effect? ex ante moral hazard Ehrlich and Becker (1972) health insurance
More informationFUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS
CENTER FOR INDUSTRY TRANSFORMATION MAY 2015 FUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS Authors Amy Bibby Partner, DHG Healthcare amy.bibby@dhgllp.com Matthew Fadel Manager, DHG Healthcare matt.fadel@dhgllp.com
More informationThe Case For Value ACA to MACRA to MIPS
The Case For Value ACA to MACRA to MIPS 2016-2019 Robert E Nesse M.D. Professor of Family Medicine Mayo Medical School Senior Director of Health Care Policy and Payment Reform nesse.robert@mayo.edu What
More informationMedicare Accountable Care Organizations What & Why?
Medicare Accountable Care Organizations What & Why? Third National Accountable Care Organization Congress David Saÿen, MBA Regional Administrator Centers for Medicare & Medicaid Services San Francisco
More informationHealth Insurance Part 2. Health Policy Eric Jacobson
Health Insurance Part 2 Health Policy Eric Jacobson The Uninsured 44 million individuals in the U.S. are without any insurance coverage at all. They tend to have below-average incomes. Nearly two-thirds
More informationOECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012
OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012 Emily Hewlett OECD Health Data National Correspondents and Health Accounts Experts Meeting, 17 th October 2013 Health System Characteristics Survey 2012 HSC
More informationThe 25th Princeton Conference
The 25th Princeton Conference Navigating Uncertainty in the U.S. Health Care System Where Medicare Is Today May 24, 2018 Mark E. Miller, Ph.D. Vice President of Health Care Laura and John Arnold Foundation
More informationHealth Care Reform Brings New Challenges, New Opportunities. November, 2010 Anne McLeod, Senior Vice President California Hospital Association
Health Care Reform Brings New Challenges, New Opportunities November, 2010 Anne McLeod, Senior Vice President California Hospital Association Hospitals play an important role in delivering care: Hospitals
More informationHEALTH ECONOMICS. Theory, Insights, and Industry Studies. 6th Edition C Rexford E. Santerre. Stephen P, Neun
6th Edition HEALTH ECONOMICS Theory, Insights, and Industry Studies Rexford E. Santerre Professor of Finance and Healthcare Manasement Department of Finance School of Business University of Connecticut
More informationSummary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE
More informationDr. Robert Riehle Jr. Wofford College 2/24/10
Dr. Robert Riehle Jr. Wofford College 2/24/10 Wofford Healthcare Symposium Our current system and its need to change Financing of the delivery system Components of an ideal delivery system What change
More informationTransition Guide. The Economics of Health Reconsidered Fourth Edition Thomas Rice, PhD, and Lynn Unruh, PhD, RN
Transition Guide The Economics of Health Reconsidered Fourth Edition Thomas Rice, PhD, and Lynn Unruh, PhD, RN Now in its fourth edition, The Economics of Health Reconsidered presents an argument that
More informationFEDERAL TRADE COMMISSION/DEPARTMENT OF JUSTICE PROPOSED STATEMENT OF ANTITRUST ENFORCEMENT POLICY REGARDING ACCOUNTABLE CARE ORGANIZATIONS
FEDERAL TRADE COMMISSION/DEPARTMENT OF JUSTICE PROPOSED STATEMENT OF ANTITRUST ENFORCEMENT POLICY REGARDING ACCOUNTABLE CARE ORGANIZATIONS On March 31, 2011, the Federal Trade Commission ( FTC ) and the
More informationANTITRUST &! TRADE REGULATION REPORT
A BNA s ANTITRUST &! TRADE REGULATION REPORT Reproduced with permission from Antitrust & Trade Regulation Report, 100 ATRR 441, 04/22/2011. Copyright 2011 by The Bureau of National Affairs, Inc. (800-372-1033)
More informationHealth-Care System Reform in Germany
Health-Care System Reform in Germany Katsuaki Matsumoto, Director Department of Health and Social Services National Institute of Public Health February 13, 2006 1 Table of Contents 1. Trends in Health-Care
More informationAdvanced Analytics. The key to unlocking the Triple Aim and Value-Based Purchasing. Ines Vigil MD, MPH, MBA
Advanced Analytics The key to unlocking the Triple Aim and Value-Based Purchasing Ines Vigil MD, MPH, MBA Advanced Analytics: The key to unlocking the Triple Aim and Value-Based Purchasing Current State
More informationMAP AUPHA. Health Administration Press, Chicago, Illinois. Association of University Programs in Health Administration, Arlington, Virginia
SIXTH EDITION HEALTH LICY issues AN ECONOMIC PERSPECTIVE PAUL J. FELDSTEIN MAP AUPHA Health Administration Press, Chicago, Illinois Association of University Programs in Health Administration, Arlington,
More informationHealth Care Spending and Spending Growth. Gail R. Wilensky Project HOPE February 18, 2011
Health Care Spending and Spending Growth Gail R. Wilensky Project HOPE February 18, 2011 1 U.S. Health Care Spending in 2009 U.S. spends a lot on health care -- Almost $2.5 trillion -- $8,086 per person
More informationHealth Economics and Financing
Health Economics and Financing Getzen, T ISBN-13: 9781118184905 Table of Contents Preface Acknowledgments About the Author Foreword CHAPTER 1 CHOICES: MONEY, MEDICINE AND HEALTH 1.1 What Is Economics?
More informationSeptember 6, Re: CMS-1600-P; CY 2014 Physician Fee Schedule Proposed rule comments
September 6, 2013 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention CMS-1600-P Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 Re: CMS-1600-P;
More informationEmbracing the Future of Care Delivery: What have we learned?
Embracing the Future of Care Delivery: What have we learned? Robert Nesse, M.D. Senior Advisor for Healthcare Policy and Payment Reform CEO, Mayo Clinic Health System 2010-2015 2014 MFMER slide-1 Fundamental
More informationCPI Antitrust Journal October 2010 (1)
CPI Antitrust Journal October 2010 (1) The Interplay Between Competition and Clinical Integration: Why the Antitrust Agencies Care About Medical Care Delivery Styles Gregory Vistnes Charles River Associates
More informationProviders Contracting Directly With Employers
Providers Contracting Directly With Employers NOVEMBER 14, 2018 1 The Current Model 2 Direct-to-Employer (DTE) Health Plan Aligned Incentives Gain Share Direct Relationship At The Table Integrated Data
More informationDraft Recommendation for Adjustment to the Differential
Draft Recommendation for Adjustment to the Differential June 13, 2018 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, Maryland 21215 (410) 764-2605 FAX: (410) 358-6217 This document
More informationHealth Care Reform Laws and their Impact on Individuals with Disabilities (Part one)
Health Care Reform Laws and their Impact on Individuals with Disabilities (Part one) ONE STRONG VOICE Disabilities Leadership Coalition Of Alabama Montgomery, Alabama December 8, 2010 Allan I. Bergman
More informationTiered Provider Networks: Trends and Evidence
Tiered Provider Networks: Trends and Evidence Anna Sinaiko, Ph.D. Department of Health Policy and Management Harvard School of Public Health June 24, 2011 1 Ancestors of Value-based Network Design HMOs,
More informationHow to Prepare for Health Care Reform Capitation Payment Systems: Controlling Costs & Managing Utilization
How to Prepare for Health Care Reform Capitation Payment Systems: Controlling Costs & Managing Utilization Mark Toso TriNet Healthcare Consultants, Inc. Introduction Health Care Reform has at its two major
More informationMarket Trends: Volume to Value. Payment for dialysis access procedures in 2016 and beyond. Controlling costs. Fee for Service Coding Changes
Market Trends: Volume to Value Reimbursement is changing from payments based on fee-for-service (FFS) (volume) to a more value-based system and will shift some risk from payors to providers. Payment for
More informationThe Emergence of Value-Based Care: Present and Future Tense
The Emergence of Value-Based Care: Present and Future Tense Erik Johnson, Vice President for Value-Based Care May 2016 What Is Value-Based Care? While the concept of value-based care has existed for years,
More informationRE: Additional Input regarding Accountable Care Organizations (ACOs) and the Medicare Shared Saving Program
221 MAIN STREET, SUITE 1500 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 February 14, 2011 Donald M. Berwick, M.D. Administrator Centers for Medicare and Medicaid Services
More informationEconomics of Policy Issues EC3060 Autumn 2016
Economics of Policy Issues EC3060 Autumn 2016 US Health Care Case Study Michael King 1 Health Care in Ireland Two-tier System: Socialised medicine with private options Socialised Medicine The government
More informationThe Costs of Doing Nothing: What s at Stake Without Health Care Reform
AARP Public Policy Institute The Costs of Doing Nothing: What s at Stake Without Health Care Reform November 2008 The Costs of Doing Nothing: What s at Stake Without Health Care Reform Table of Contents
More information04/12/2016 C H A L L E N G E S F A C I N G U N I T E D S T A T E S H E A L T H C A R E S Y S T E M
M I C H A E L J. S E E L, M. D. I M P L E M E N T I N G C H A L L E N G E S F A C I N G U N I T E D S T A T E S H E A L T H C A R E S Y S T E M Emphasis on Health care, not Health Fragmented Delivery and
More informationACOs/Shared Savings Demonstration Project: What Does It All Mean?
ACOs/Shared Savings Demonstration Project: What Does It All Mean? None Conflicts of Interest Sean P. Roddy, MD Albany, NY Accountable Care Organizations Term introduced in 2006 by Fisher et al. the hospital
More informationNavigating the Briar Patch: Addressing Regulatory Compliance in an Alternative Payment World Business of Healthcare Symposium, March 5, 2018 Barry S.
Navigating the Briar Patch: Addressing Regulatory Compliance in an Alternative Payment World Business of Healthcare Symposium, March 5, 2018 Barry S. Herrin, JD, FACHE Founder, Herrin Health Law, P.C.
More informationPopulation-Based Healthcare: Structural Models and Options
Population-Based Healthcare: Structural Models and Options George Choriatis, Esq. Rivkin Radler LLP Presented at: Annual Fall Meeting New York State Bar Association Health Law Section Albany, New York
More informationHealth Insurance Glossary of Terms
1 Health Insurance Glossary of Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
More informationHealth Care Reform Eric H. Schultz, President and CEO
Health Care Reform Eric H. Schultz, President and CEO Sentinel Benefits & Financial Group September 21, 2011 Affordable Care Act The Basics Insures the uninsured Individual and employer mandates Reforms
More informationWisconsin State Health Exchange Policy Paper
Wisconsin State Health Exchange Policy Paper June, 2011 Overview Wisconsin has maintained a very low uninsured rate for many years and annually ranks at or near the top nationally in health care quality.
More informationACA in Brief 2/18/2014. It Takes Three Branches... Overview of the Affordable Care Act. Health Insurance Coverage, USA, % 16% 55% 15% 10%
Health Insurance Coverage, USA, 2011 16% Uninsured Overview of the Affordable Care Act 55% 16% Medicaid Medicare Private Non-Group Philip R. Lee Institute for Health Policy Studies Janet Coffman, MPP,
More informationThe Center for Hospital Finance and Management
The Center for Hospital Finance and Management 624 North Broadway/Third Floor Baltimore MD 21205 410-955-3241/FAX 410-955-2301 Mr. Chairman, and members of the Aging Committee, thank you for inviting me
More informationExhibit ES-1. Total National Health Expenditures (NHE), Current Projection and Alternative Scenarios
Exhibit ES-1. Total National Health Expenditures (NHE), 2009 2020 Current Projection and Alternative Scenarios NHE in trillions $6 $5 Current projection (6.7% annual growth) Path proposals (5.5% annual
More informationFrequently Asked & Answered Questions NY Health and Medicare
Frequently Asked & Answered Questions NY Health and Medicare Pending state legislation known as NY Health would ensure that ALL New Yorkers have comprehensive insurance coverage through a single payer
More informationCameron ECON 132 (Health Economics): FINAL EXAM (A) Fall 2016 Multiple Choice (1 points each question) CIRCLE ONE
Cameron ECON 132 (Health Economics): FINAL EXAM (A) Fall 2016 Answer all questions in the space provided on the exam. Total of 60 points (and worth 44.5% of final grade). Read each question carefully,
More informationA New Ownership Society in Health Care
A New Ownership Society in Health Care Consumer-Driven Healthcare Summit September 26, 2007 James C. Robinson Editor-in-Chief, Health Affairs OVERVIEW The old ownership society: consumerism Towards a new
More informationGrowth and Success of Accountable Care Organizations (ACOs) in the US from Dennis Horrigan June 2016
Growth and Success of Accountable Care Organizations (ACOs) in the US from 2010-2016 Dennis Horrigan June 2016 Introducing Dennis Horrigan Dennis R. Horrigan President and Chief Executive Officer Catholic
More informationMerger of Statutory Health Insurance Funds in Korea
Merger of Statutory Health Insurance Funds in Korea WHO meeting, Oxford Dec 16-18, 2014 Soonman Kwon, Ph.D. Professor and Former Dean, School of Public Health Director, WHO Collaborating Centre For Health
More informationACO Emerging Trends -Lessons Learned on ACO Start-Up
ACO Emerging Trends -Lessons Learned on ACO Start-Up This roundtable discussion is brought to you by the ACO Task Force September 14, 2012, Noon to 1:15 pm Eastern Presenters: Christi J. Braun, Esquire
More informationSociety of Professors of Child and Adolescent Psychiatry. Michael Jellinek, M.D. May 9, 2013
Society of Professors of Child and Adolescent Psychiatry Michael Jellinek, M.D. May 9, 2013 Health Care Reform: Drivers Extend Coverage (Social justice and efficiency) Cost (versus public acceptance, politics)
More informationMedicare Supplement Insurance (Medigap) Review
Medicare Supplement Insurance (Medigap) Review 1 Medicare Part A (Hospital Insurance) Part A Covers: Inpatient hospital care Care in a skilled nursing facility (SNF) Home health care Hospice care Blood
More informationMcKinney s Public Health Law 2999-n n. Accountable care organizations; findings; purpose. Effective: October 3, 2012
2999-n. Accountable care organizations; findings; purpose, NY PUB HEALTH 2999-n McKinney s Consolidated Laws of New York Annotated Public Health Law (Refs & Annos) Chapter 45. Of the Consolidated Laws
More informationComment Does the economics of moral hazard need to be revisited? A comment on the paper by John Nyman
Journal of Health Economics 20 (2001) 283 288 Comment Does the economics of moral hazard need to be revisited? A comment on the paper by John Nyman Åke Blomqvist Department of Economics, University of
More informationThe Medicare Shared Savings Program. November 2011
The Medicare Shared Savings Program November 2011 Overview CMS vision and goals Medicare Shared Savings Program operation highlights Next steps 2 ACO Vision An ACO promotes seamless coordinated care Puts
More informationOP ED: Grocers Get It, Why Doesn t Government? Solutions That Work
OP ED: Grocers Get It, Why Doesn t Government? Solutions That Work How can we fix only the flat tire on the healthcare vehicle and NOT call the whole thing a clunker, sending it to the government-run junkyard
More information9/23/2016. Our Services. Transitioning from Fee-for-Service to Value-based Reimbursement. Key Trends and Strategies for Rural Health Providers
Transitioning from Fee-for-Service to Value-based Reimbursement Key Trends and Strategies for Rural Health Providers Paul MacLellan, CEO >> Health care consulting company >> Wholly owned subsidiary of
More informationFINANCIAL ASSISTANCE POLICY SUMMARY
Reviewed: 02/09, 9/19/13, 7/17 Authority: EC Revised: 10/09, 06/15/10, 3/2/11, 10/02/13, 2/1/16, 11/17 Page: 1 of 14 FINANCIAL ASSISTANCE POLICY SUMMARY SCOPE: This policy applies to the following Adventist
More informationTotal Cost of Care (TCOC) Workgroup. January 30, 2019
Total Cost of Care (TCOC) Workgroup January 30, 2019 Agenda Introductions Updates on initiatives with CMS Y1 MPA (PY18) Implementation Timing Y2 MPA (PY19) MPA Operations Reporting and Attribution Stability
More informationOpportunities and Challenges for Public sector Medical Insurance Schemes in a Private Sector Ms B Mfenyana 06 October 2016 Second colloquium
Opportunities and Challenges for Public sector Medical Insurance Schemes in a Private Sector Ms B Mfenyana 06 October 2016 Second colloquium Contents Purpose GEMS Background Mandate, Mission, Vision, and
More informationSide-by-Side Comparison of House and Senate Healthcare Reform Proposals
Side-by-Side Comparison of House and Senate Healthcare Reform Proposals On November 7, 2009, the U.S. House of Representatives passed the Affordable Health Care for America Act (HR 3962). On November 21,
More informationAssessing ACO Performance
Assessing ACO Performance David V. Axene, FSA, FCA, CERA, MAAA As more health plans utilize Accountable Care Organizations (i.e., ACOs) as part of their network operations, ACO performance assessment is
More informationHow ACO s Can Impact Contracting A Real World Example. Mike Medel Pharm D, MBA Banner Health
How ACO s Can Impact Contracting A Real World Example Mike Medel Pharm D, MBA Banner Health Agenda Banner Pharmacy Services Introduction Accountable Care Organization Summary Basic Constructs of ACO Partnership
More informationSheryl T. Dacso, J.D., Dr.P.H.
Highlights of the New Health Care Reform and its Impact on the Legal Industry Presented to the Houston Metropolitan Paralegal Association November 9, 2010 Sheryl T. Dacso, J.D., Dr.P.H. sdacso@seyfarth.com
More informationManaging HIPAA Privacy in a Value-based Environment
Managing HIPAA Privacy in a Value-based Environment Margret Amatayakul, MBA, RHIA, CHPS, CPHIT, CPEHR, CPHIE, FHIMSS President, Margret\A Consulting, LLC An independent consulting firm focusing on optimizing
More informationThe Effect Of Health Insurance On Health Care Utilization: Evidence From Malaysia
ISSC 2016 : International Soft Science Conference The Effect Of Health Insurance On Health Care Utilization: Evidence From Malaysia Arpah Abu-Bakar a *, Shamzaeffa Samsudin b, Angappan Regupathi c, Syed
More informationA leading provider of post acute services
A leading provider of post acute services March 2018 2018 by Genesis Healthcare, Inc. All Rights Reserved. Safe Harbor Statement Certain statements in this presentation regarding the expected benefits
More informationCoverage Expansion [Sections 310, 323, 324, 341, 342, 343, 344, and 1701]
Summary of the U.S. House of Representatives Health Reform Bill October 2009 The following summarizes the major hospital and health system provisions included in the U.S. House of Representatives health
More informationCameron ECON 132 (Health Economics): SECOND MIDTERM EXAM (A) Fall 17
Cameron ECON 132 (Health Economics): SECOND MIDTERM EXAM (A) Fall 17 Answer all questions in the space provided on the exam. Total of 36 points (and worth 22.5% of final grade). Read each question carefully,
More informationIs There a Role for the Orthopaedic Surgeon in ACOs?
Is There a Role for the Orthopaedic Surgeon in ACOs? Michael R. Redler, MD Head Team Physician Sacred Heart University Visiting Assistant Clinical Professor University of Virginia Orthopaedic Consultant
More informationTHE FUTURE OF HEALTHCARE: TRENDS THAT WILL AFFECT YOUR PROFESSIONAL AND PERSONAL LIFE
THE FUTURE OF HEALTHCARE: TRENDS THAT WILL AFFECT YOUR PROFESSIONAL AND PERSONAL LIFE Dr. Keith Hornberger, BSRT, MBA, DHA, FACHE 1 The Future Direction of Healthcare Healthcare Reform will catalyze a
More informationpartnering with payers? key lessons to keep in mind
REPRINT January 2014 Bill Eggbeer Kevin Sears Kenneth Homer healthcare financial management association hfma.org partnering with payers? key lessons to keep in mind As providers enter into risk-sharing
More informationSent via electronic transmission to:
March 3, 2017 Patrick Conway, MD Acting Administrator Centers for Medicare and Medicaid Services US Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201 Sent via electronic
More informationMedicare Advantage (Part C) Review
Medicare Advantage (Part C) Review 1 Medicare For people 65+ and under 65 with a disability 4 parts of Medicare Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Plans Part
More informationAdmitting Privileges: The right granted to a doctor to admit patients to a particular hospital.
Glossary of Health Care Terms Adapted from the Health Insurance Resource Center Admitting Privileges: The right granted to a doctor to admit patients to a particular hospital. Benefit: Amount payable by
More informationQUESTION 1 QUESTION 2
QUESTION 1 Consider a two period model of durable-goods monopolists. The demand for the service flow of the good in each period is given by P = 1- Q. The good is perfectly durable and there is no production
More informationRobert Resnik MD MBA
Robert Resnik MD MBA Movement from FFS to Value Based Value Based Spectrum P4P Clinical Integration Shared Savings Bundled Payments Shared Risk Capitation Global Full Risk Partial Risk ACO vs. Clinically
More informationValue, Innovation, Costs and Benefits. Mark Ferdinand Senior Director, Health and Economic Policy Ottawa, ON April 17, 2012
Value, Innovation, Costs and Benefits Mark Ferdinand Senior Director, Health and Economic Policy Ottawa, ON April 17, 2012 Value Value Defining Value Will it work for me? Is this cheaper? Will I have to
More informationNarrowed Networks in the Healthcare Exchange. Prepared by: Gladys S. Chuy, MHA Candidate 2016
Narrowed Networks in the Healthcare Exchange Prepared by: Gladys S. Chuy, MHA Candidate 2016 1 Overview I. Introduction and Background II. Understanding Current State III. What are the Main Issues IV.
More informationALSTON&BIRD LLP. Summary of Agency Proposals Related to Accountable Care Organizations and the Medicare Shared Savings Program. I.
ALSTON&BIRD LLP Summary of Agency Proposals Related to Accountable Care Organizations and the Medicare Shared Savings Program I. Executive Summary On March 31, 2011, the Centers for Medicare & Medicaid
More informationA leading provider of post acute services
A leading provider of post acute services May 2017 2017 by Genesis Healthcare, Inc. All Rights Reserved. Safe Harbor Statement Certain statements in this presentation regarding the expected benefits of
More informationFederal Health Care Reform
Federal Health Care Reform Presentation to Behavioral Health Collaborative Katie Falls, HSD Secretary May 26, 2010 1 Health Care Reform Areas of Impact Insurance Reforms Medicare Medicaid Quality Improvement
More informationCommon Managed Care Terms & Definitions
Contact Us: Email: info@emedbiz.com Phone: 561-430-2090 Fax: 561-430-2091 Website: www.emedbiz.com Common Managed Care Terms & Definitions Balance billing: The practice of billing a patient for the amount
More informationDisclosure of Hospital Financial and Statistical Data: Fiscal Year 2015
Disclosure of Hospital Financial and Statistical Data: Fiscal Year 2015 Issued August 3, 2016 Updated August 31, 2016 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, Maryland 21215
More informationCPI Antitrust Chronicle July 2012 (1)
CPI Antitrust Chronicle July 2012 (1) Health Care Reform, Provider Affiliations, and Antitrust Risks Lona Fowdur & John M. Gale Economists Incorporated www.competitionpolicyinternational.com Competition
More informationEconomic Evaluations in Health An introduction for clinicians, researchers, and policy makers
Economic Evaluations in Health An introduction for clinicians, researchers, and policy makers Philip Leonard, PhD, MSSU and UNB Economics May 16, 2016 Saint John Regional Hospital, NB Economics in health
More informationDisclosure of Hospital Financial and Statistical Data: Fiscal Year 2016
Disclosure of Hospital Financial and Statistical Data: Fiscal Year 2016 April 12, 2017 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, Maryland 21215 (410) 764-2605 FAX: (410) 358-6217
More informationProposed ACO Rule: A Giant Step Toward Reform or a Leap of Faith for Providers? April 27, 2011
Proposed ACO Rule: A Giant Step Toward Reform or a Leap of Faith for Providers? April 27, 2011 Barbara Eyman Ropes & Gray Barbara.Eyman@ropesgray.com 202.508.4760 Ropes & Gray LLP Stephen Warnke Ropes
More informationLong-Term Care An Actuarial Perspective on Societal and Personal Challenges
Long-Term Care An Actuarial Perspective on Societal and Personal Challenges Sam Gutterman FSA, FCAS, CERA, MAAA, HonFIA co-vicechairperson IAA Population Issues Working Group sam.gutterman1@gmail.com 1
More informationUniversal Healthcare. Universal Healthcare. Universal Healthcare. Universal Healthcare
Universal Healthcare Universal Healthcare In 2004, health care spending in the United States reached $1.9 trillion, and is projected to reach $2.9 trillion in 2009 The annual premium that a health insurer
More informationPatient Cost Sharing in Low Income Populations
American Economic Review: Papers & Proceedings 100 (May 2010): 303 308 http://www.aeaweb.org/articles.php?doi=10.1257/aer.100.2.303 Patient Cost Sharing in Low Income Populations By Amitabh Chandra, Jonathan
More informationCHCS. Technical Assistance. Tool. Implementing the Medicaid Primary Care Rate. Increase: A Roadmap for States. Center for Health Care Strategies, Inc.
CHCS Center for Health Care Strategies, Inc. Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States Technical Assistance Tool N OVEMBER 2011 T he Affordable Care Act s (ACA) expansion
More informationGulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business?
Gulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business? Richard R. Vath, MD FMOLHS SVP/Chief Clinical Transformation Officer President Health Leaders Network and Medicare ACO
More informationTaming the Cost of Health Care
Senator Richard T. Moore Senate Chairman, Joint Committee on Health Care Financing Taming Health Costs States Making A Difference July 27, 2010 Louisville, Kentucky Overview Massachusetts Health Reform
More informationWhen the Dust Settles-What s Next?
When the Dust Settles-What s Next? AMA IPPS Conference Robert Nesse M.D. Senior Director of Payment Reform Mayo Clinic nesse.robert@mayo.edu What is Driving the Change in Healthcare? Common Belief: The
More informationHow Bundled Payments Create Value in New Product Designs Cognizant
How Bundled Payments Create Value in New Product Designs 1 About Cognizant 2 This Will Not Take Long. 3 What is a Health Insurance Product? 4 Understanding Product Design Commercial Insurance One specific
More informationAetna s value based payment models aim to pay for value delivered, not services rendered
Aetna s value based payment models aim to pay for value delivered, not services rendered Aetna currently has 22% of spend running through contracts with a value based component. Value Based Contracting
More informationGMCB Update Health Reform Oversight Committee. Chair Kevin Mullin and Michael Barber October 25, 2018
GMCB Update Health Reform Oversight Committee Chair Kevin Mullin and Michael Barber October 25, 2018 1 2 Hospital Budgets Hospitals initially requested a 2.9% increase in Net Patient Revenue (NPR) from
More informationUS Reimbursement Systems: Effects on R&D
US Reimbursement Systems: Effects on R&D Patricia M. Danzon, PhD Professor Emeritus The Wharton School University of Pennsylvania Theory: Optimal Reimbursement Rules to Create Efficient R&D Incentives
More informationStuart H. Altman. The Changing Health Care System: Economic Forces Pushing States To Become More Involved
The Changing Health Care System: Economic Forces Pushing States To Become More Involved Stuart H. Altman Sol Chaikin Professor of Health Policy The Heller School for Social Policy and Management Brandeis
More informationSocietal Risks and the Law 1
1 / 28 Societal Risks and the Law 1 Statistics/CS/Poli Sci C79 Jasjeet S. Sekhon UC Berkeley March 12, 2013 1 c Copyright 2012 Jasjeet S. Sekhon 2 / 28 Cell Phone Insurance versus Health We only lightly
More information