Health Care Delivery

The theory that a lack of coordination leads to poor health outcomes and higher costs drives US healthcare policy. But for the first time, a new study in The American Journal of Managed Care measures this phenomenon-and confirms it.

A hospital visit prompts an exchange about an "Alabama plan" to expand Medicaid in a state that is trying for find new funding sources for adult mental health services.

According to Robert Pozen, non-resident senior fellow at Brookings, government healthcare plans were 17.5% higher cost than the average citizen's plan, while their employee contributions were 45% less than the average plan. If these patterns continue, many state and city healthcare plans will run up against the "Cadillac" tax in 2018, he predicts.

The Maryland Health Connection, the state's insurance exchange, employed a number of strategies in during the second open enrollment period to get consumers signed up, explained Carolyn Quattrocki, executive director of the Maryland Health Benefit Exchange, the agency that operates Maryland Health Connection.

The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from a command center near Charlotte. The command center is staffed 24/7 with a rotating crew of 7 to 9 nurses and doctors who specialize in critical care.

Medicare's new payment formula is set to begin in 2019. The problem is no one's agreed on standards for measuring quality or efficiency of patient care.

The White House is moving to address 2 of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

It's an incorrect, but convenient, shorthand to say that the Affordable Care Act establishes state-based health insurance markets. Actually, the markets are finer grained than that.

It is unclear at this time what role President Barack Obama's healthcare law, the Affordable Care Act, played in the slowdown of healthcare spending and how much can be attributed to the Great Recession.

Health and Human Services Secretary Sylvia Mathews Burwell yesterday rejected Governor Rick Scott's proposal to extend the current funding mechanism, which this year brought $1.3 billion in federal funds to hospitals that care for high numbers of uninsured patients.

Among other topics, panelists discussed the connection between mental health and diabetes, and the need to treat these conditions together.

The Affordable Care Act provided funds for 10 states to experiment with incentive programs in Medicaid. Researchers hope to learn what steps will motivate beneficiaries to take steps to improve their health.

MNsure's chief executive announced his resignation Monday, paving the way for a third leadership shakeup at the beleaguered agency in less than 2 years.

A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. But a new study found that when hospitals shut down, death rates and other markers of quality generally do not worsen.

When 5% of Medicaid recipients account for 54% of spending, cost is just the beginning of the problem.

The Pioneer ACO Model successfully reported smaller increases in total Medicare expenditures and reductions in health service utilization, for savings of approximately $385 million during the first 2 years compared with general Medicare fee-for-service.

The number of Americans finding coverage through Medicaid expansion equals those who signed up for private insurance on the exchanges, according to new data. Montana has just passed legislation to become the 29th state to expand Medicaid.

The increased availability of urgent care centers, retail clinics, and telephone triage lines has not affected emergency department (ED) visits. In fact, three-fourths of emergency physicians report ED visits are going up.

As accountable care organizations work to deliver population health, patient satisfaction, and cost savings, the need to engage patients as partners in their own healthcare has never been more essential. The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, gathered this week at the historic Hotel del Coronado in San Diego, California, to explore ways to make patients the starting points of healthcare, not just its recipients.

Patients at hospitals with high rates of skilled nursing facility discharge usually have poorer outcomes and higher downstream spending, according to researchers from Massachusetts Institute of Technology and Vanderbilt University.