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Mal Allison

With Change Coming, Aetna Targets Employers - NYTimes.com - 0 views

  • Mr. Mead cited a report by the Institute of Medicine that tallied more than $760 billion in health care “waste” created annually as a result of consumer fraud, unnecessary procedures and excessive administrative costs.
  • r. Mead said the campaign also stressed the need for health care providers to shift to a model known as “accountable care,” which shifts their reimbursement models for health care professionals from being paid for the volume of services they perform to being paid based on the outcomes of patient care. Accountable care systems are usually linked to technologies that help health care providers measure performance and manage patient data. Aetna has 27 accountable health care agreements with hospitals and other health care providers around the country.
  • Bertolini said in the video. “If we fix just 20 percent of it, we could pay for the Affordable Care Act. We could insure everyone without increasing taxes.”
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  • The fee-for-service model is broken,” Mr. Mead said. “The Affordable Care Act encourages the system to move to accountable care,” he added. “The challenge with that is that doctors and hospitals need technology and support to make that work.”
  • He noted how costs could vary widely depending on where a person lived and who their insurer was. “It shouldn’t vary that much,” Mr. Huckman said.
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    Aetna, one of the largest of the companies, will introduce a new campaign on Tuesday aimed at those groups. It will highlight the company's goal of cutting billions of dollars of expenditures through so-called Big Data, electronic health records and other technologies as well as encouraging better coordination among health care providers. The campaign, called "Our Healthy," will run online, in print and on mobile devices through the end of 2013.
Mal Allison

Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality - Kaiser Health News - 0 views

  • The current system, researchers say, financially encourages doctors to do more procedures and is one of the reasons health costs have escalated. The health law required Medicare to gradually factor in quality into payments for hospitals, nursing homes, physicians and most medical providers.
  • Medicare had already decided that large physician groups -- those with 100 or more doctors, nurses, social workers or other health professionals -- will gain or lose as much as 1 percent of their pay starting in 2015. Those incentives would double to 2 percent the following year under draft regulations Medicare released this month. The proposal also would phase mid-sized physicians groups—those with between 10 and 99 health professionals—into the program in 2016 instead of in 2017. While they would be eligible for bonuses up to 2 percent, they would be shielded from any penalties for that first year.
Mal Allison

Medical-Price Inflation Is at Slowest Pace in 50 Years - WSJ.com - 0 views

  • "Fifteen years ago, pricing was not as important…[but] when the co-pay is coming out of a patient's pocket, they more often want to know what they're paying," said Moshir Jacob, medical director at the Toledo Clinic. The Ohio practice advertises that it offers lower prices than area hospita
  • Others doubt there has been a structural change. "We haven't done anything in the past three or four years that fundamentally altered the health-care system," said Gerard Anderson of Johns Hopkins University, who was the lead author of the "It's the Prices, Stupid" paper a decade ago. "And everything in Obamacare that tried to control cost was watered down."
  • The system now offers members a choice: Have your procedure at one of 51 hospitals that agreed to limit what they charge, or have the surgery elsewhere and pay any expenses above $30,000 out of pocket.
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  • In the program's first year, the cost per surgery declined 19%, and patient outcomes were as good or better, according to Calpers. "It gets to the myth that high prices equate to better quality," said Ann Boynton of Calpers. "In some cases, it's just the opposite."
Mal Allison

State making headway in curbing health costs, but leaders worry about backsliding - Met... - 0 views

  • Companies are increasingly offering employees health plans that allow them more freedom to choose doctors and hospitals and that generally do not require referrals from primary care doctors for specialty care.
  • insurers generally still pay a fee for every visit and procedure, a payment system that has been blamed for driving up spending.
  • this movement back toward’’ fee-for-service medicine “is really going to hurt us.’’
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