Editorials

Using advanced technology to improve quality across the care spectrum: best practices in value-based care

Much of the early discussion around technology needs for value-based care has been about data interoperability. At a basic level, these models require interoperable systems that can share patient data across providers. This integrated data will also be used by payers to assess the model’s performance.

What if the healthcare cost crisis solves itself?

Conventional wisdom is that cutting Medicare rates shifts the burden to the private sector, but an intriguing article in Health Affairs reaches a counterintuitive conclusion.

A Health Insurance Exchange That Won't Be a "Train Wreck"

Every week, I get an email from the Maryland Health Connection -- the state run health insurance exchange. Maryland is one of a minority of states that are building their own Affordable Care Act ("ObamaCare") exchange.

Achieving ObamaCare Goals without ObamaCare

When 21-year-old Mike Kelly (not his real name) set out on his bicycle one evening in Durango, Colorado, he had no intention of ending up in a hospital. A collision with an automobile changed those plans. Fortunately, Durango is a ski mecca where broken bones are almost a way of life. With all that practice, doctors there have evolved their practice into a sort of natural center of excellence for treating bone injuries.

Here Come the Cuts

As the dust settles from the Supreme Court's ruling on the constitutionality of the Affordable Care Act (ACA), the results of the presidential election and, more recently, the sequester cuts, acute care providers are now turning attention to the looming reimbursement cuts.

Preventing Physician Abrasion Related to Claims Payment

Although physicians have always valued prompt, accurate and complete claims payment, the need for such payment has become more important as physician practices try to balance increasing costs with shrinking reimbursement.

Report Card on ObamaCare

Over the next 10 years health reform will impose upon us about $1 trillion in new taxes and it will take another $716 billion out of Medicare, imperiling access to care for the elderly and the disabled according to Medicare's Office of the Actuaries. It will impose a mandate to buy health insurance on most people and fine us if we don't comply. It will compel all but the smallest employers to provide insurance to their employees and fine them if they don't.

Big Data and the Future of the Health Insurance Market

While the Affordable Care Act's individual mandate was naturally expected to drive the previously uninsured to non-group plans, it has become increasingly clear that the individual market is also bracing for a potentially significant influx of currently insured enrollees who are driven there both by choice and necessity.

A more positive outlook on provider consolidation

You should read Dr. Scott Gottlieb's opinion piece in the Wall Street Journal (The Doctor Won’t See You Now. He’s Clocked Out). He argues that ObamaCare is making independent physician practices obsolete by forcing physicians to work for big hospitals as part of ACOs, is imposing high costs for information technology on those who try to remain independent, and that the Administration's policies will have the ironic consequence of driving up costs since employed physicians are less productive.

Paying for Care

If you were eating in a Chinese restaurant, would you have the temerity to tell the manager how to repackage and re-price the items on the menu?