Why Medicaid Managed Care Is Looking Outside the Traditional Coverage Box

Social determinants of health come into focus to keep beneficiaries out of the hospital.

The Affordable Care Act and Cancer Care Delivery

The Affordable Care Act (ACA) has reformed US health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with preexisting condition clauses, have helped more than 20 million Americans gain health care coverage. Accountable care organizations, oncology patient-centered medical homes, and the Oncology Care Model-all implemented through the Center for Medicare & Medicaid Innovation-have initiated an accelerating shift toward value-based cancer care. Concurrently, evidence for better cancer outcomes and improved quality of cancer care is starting to accrue in the wake of ACA implementation.

The Edge of Success

Make it through the challenges of forming an accountable care organization (ACO) for just a couple of years, and the money your groups save can be spectacular - into the millions under the right circumstances.

ACOs Sit Like Gibraltar in Rough Seas of Change

The ACO, a creature of the ACA that often gets confused with its progenitor, seems like it will survive-and maybe even thrive-in whatever healthscape emerges from the Republican anti-ACA push. But just what will happen to the various forms of the ACO that are now in place?

Using health information technology to manage a patient population in accountable care organizations

Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.

A tale of two ACOs

Hospital systems and physician practices setting up accountable care organizations are generating mixed results. Whether you profit from shared savings will often depend on where you start--and that's a problem.

Cost of diagnosing psoriasis and rosacea for dermatologists versus primary care physicians

Growing incentives to control health care costs may cause accountable care organizations (ACOs) to reconsider how skin disease is best managed. Limited data have suggested that disease management by a primary care physician (PCP) may be less costly than seeing a specialist, though it is not clear if the same is true for the management of skin disease. This study assessed the cost of seeing a dermatologist versus a PCP for diagnosis of psoriasis and rosacea.

Saving Lives and Saving Money: The Role of North Carolina Health Departments in Medicaid Managed Care

A new Medicaid system is emerging in North Carolina in which accountable care organizations will aim to improve both the quality and value of health care. We explore how local health departments can apply their expertise in population health to help achieve these goals.