Health policy experts writing in the current issue of
The papers discuss the promises and challenges of the various approaches, as these programs must cope with an aging population beset with chronic health problems while also balancing rising costs.
“Access to and affordability of high-quality health care are among the most important policy issues for many Americans,” said
Studies featured in this issue found:
Physician-initiated payment reform offers a path toward value. This analysis of the first set of new payment models initiated by physicians and not payers to create more value in Medicare found that the models shared several important features, including acceptance of financial risk, case management and new technologies to support care delivery. These payment models were submitted to the
A more accurate way to predict patients at high risk for hospitalization. Health systems use predictive models to try and determine which patients may have a high risk of readmission but using a single risk score may lead to false results. An article using a large data set from the
Medicare Advantage payment cut did not hurt enrollment. Another study examined Medicare Advantage payment cuts to see if the reductions affected healthcare access and affordability for enrollees compared with beneficiaries in traditional Medicare fee-for-service plans. While some thought the payment cuts would deter both plans and enrollees from joining the privately managed plans, enrollment grew steadily from 2009 to 2017. The plans were able to reduce their costs for providing both Part A and Part B benefits, say
Unmet needs among enrollees with serious mental illness in Medicaid managed care. Most states have moved their Medicaid programs to managed care models, but little information exists about how these models work for those with serious mental illness. This article, by
For the full issue, click here.