Reimbursement

Throughout his career – as a pediatrician, Harvard professor and now CMS administrator – Donald Berwick has been a fan of quality guru W. Edwards Deming.

Steward Health Care System, the largest integrated community care organization and community hospital network in New England, announced last week that it is teaming with Tufts Health Plan to create a community hospital network health plan aimed at dramatically deceasing health insurance costs for small businesses.

CMS will use the claims and provider data to support policy activities and reimbursement for the Medicare Shared Savings and Pioneer ACO Model programs.

The wild attacks on Social Security by Republican presidential candidates including Rick Perry's famous characterization of the program as "a Ponzi scheme" are amusing, but are a serious distraction from the real fiscal issues facing the country.

Medicaid health plans will need to pay more attention to waste, abuse and fraud as federal and state agencies step up scrutiny to cut incorrect payments and reduce costs.

U.S. healthcare prices increased ever so slightly in August 2011, rising 0.1 percent, according to the federal Bureau of Labor Statistics.

During the health care debate, the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system.

A recent study in Health Affairs examines for the first time the effects that differences in healthcare service volume and price, rather than simply spending and use, have on state and regional Medicaid spending.

Two-thirds of low income individuals who receive Medicaid are enrolled in comprehensive managed care programs, including risk-based managed care organizations (MCO) and primary care case management programs.