Administration starts final ObamaCare push

The Obama administration is making a push to strengthen ObamaCare and make it more sustainable before leaving office.

The enrollment period for 2017, which begins Nov. 1, comes at a challenging time for the healthcare law. Insurers have been dropping out of its marketplaces and hiking premiums due to financial losses from ObamaCare plans.

Reversing that trend will require more people and healthier people to sign up.

The administration projected Wednesday that about 1 million more people would sign up for ObamaCare insurance plans for 2017, bringing total enrollment to 13.8 million. The goal is modest, but meeting it could help ease concerns in the insurance industry.

“The biggest opportunity we have to strengthen the Marketplace with a bigger, healthier risk pool is right in front of us — this upcoming open enrollment,” Health and Human Services (HHS) Secretary Sylvia Mathews Burwell said Wednesday. “This is the last open enrollment for this administration. We’re going to make it count.”

The mere projection of an increase in enrollment has calmed nerves in the healthcare world. Some had speculated that ObamaCare enrollment could even decline next year due to premium hikes or insurers leaving the system.

“I’m encouraged that it does show continued growth,” said Joel Ario, a former HHS […]

By |October 24th, 2016|Health Reform|Comments Off on Administration starts final ObamaCare push

MACRA Final Rule Includes Some Changes

The much-anticipated final rule implementing the Medicare physician payment overhaul features several changes from a previously proposed version, including plans for new alternative payment models (APMs).

The final rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) outlined physician payments under the Quality Payment Program (QPP), which replaces the sustainable growth rate formula and will apply to Medicare payments for more than 600,000 clinicians, according to the Centers for Medicare & Medicaid Services (CMS). Most physicians under QPP initially are expected to fall under the Merit-based Incentive Payment System (MIPS), while a smaller number will qualify for payment through participation in advanced APMs.

A new CMS QPP website explains the new program and aims to help clinicians identify the measures and activities most meaningful to their practice or specialty.

Clinicians who start participating in Medicare in 2017 are not required to participate in the QPP in that year.

Under QPP, clinicians will have until Oct. 2, 2017, to begin collecting quality data or face a 4 percent cut to their Medicare payments in 2019. The 2017 data is due by March 31, 2018. Providers can avoid a payment adjustment by submitting a small […]

By |October 24th, 2016|Health Reform, Medicare/Medicaid|Comments Off on MACRA Final Rule Includes Some Changes

Medicaid Programs Expanding Payment Reforms

State Medicaid programs are increasingly adopting payment and delivery reform initiatives, according to the latest national tracking survey.

The share of Medicaid programs adopting or expanding payment and delivery reform programs will grow to 25 states in FY17, up from 21 states in FY16, according to the latest state Medicaid budget survey from the Kaiser Family Foundation and National Association of Medicaid Directors.

“The initiatives and strategies are significant for how they coordinate and integrate care across physical health, behavioral health, and long-term care, and many of them explicitly include strategies to determine the social determinants of health,” said Vernon Smith, a senior fellow at Health Management Associates, which helped conduct the survey.

The biggest surge in the prevalence of reform models in Medicaid will come from the use of accountable care organizations (ACOs), which 11 states will create or expand in FY17, up from five that did so in FY16. Only three states launched or expanded ACOs in FY15.

Three states—Missouri, Pennsylvania and Rhode Island—were adding provisions to their Medicaid managed care contracts either encouraging or requiring those insurers to contract with ACOs. Vermont is moving its Medicaid ACO to a two-sided model and is […]

By |October 24th, 2016|Health Reform, Medicare/Medicaid|Comments Off on Medicaid Programs Expanding Payment Reforms


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