KPMG: Providers, payers hesitant about Medicare ACO participation
Leaders of healthcare systems, hospitals and healthcare payers are on the fence when it comes to their participation in the Centers for Medicare & Medicaid Services' shared savings program (MSSP) – the Medicare ACO program – according to a recent poll by KPMG LLC. According to responses to webcast polls conduct in April, 39 percent of hospital and health system executives didn't know their organization's position on participating in the MSSP. Another 25 percent said they were taking a wait-and-see approach, which wouldn't allow them to be ready for the launch of the program, currently slated for Jan. 1, 2012, under the current rules proposed by CMS. Among the payer group, nearly half said they didn't know what their organization's stance was on the MSSP and 21 percent were taking a wait-and-see approach.
PwC: Insurance exchanges will create $200B market for payers
A report from the PricewaterhouseCoopers U.S. Health Research Institute finds that policies offered by state health insurance exchanges could be worth nearly $60 billion by 2014 – and grow to nearly $200 billion by 2019. Consumers, meanwhile, will enjoy "purchasing power that will make health insurers want to work harder to win their business and loyalty." As insurers eye the new pools, the report finds, one of their chief concerns is the ability to integrate technology with the exchanges. The Congressional Budget Office estimates that 12 million consumers will buy health insurance in the exchange market in 2014, rising to nearly 28 million consumers by 2019. Despite concerns and unresolved legal and design questions, many insurers feel they can't afford to opt out of health insurance exchanges.
Independence Blue Cross signs three-year P4P deal with Abington Health
Independence Blue Cross has signed a three-year contract with a third provider group – Abington Health – for its new hospital/physician incentive program, which aims to move away from a fee-for-service reimbursement model and instead reward improved quality and lower-cost care. The incentive program, called the Integrated Provider Performance Incentive Plan (IPPIP), is based on an accountable care model that provides incentives to hospitals and physicians to collaborate on efforts to reduce hospital acquired infections and readmissions, and to ensure evidence-based guidelines are followed for surgical care and the treatment of heart attacks, heart failure and pneumonia.
Government puts new tech to work on Medicare fraud
The government has found a new high-tech way to crack down on fraud in the Medicare program – predictive modeling. The Centers for Medicare & Medicaid Services said the initiative, which started on July 1, uses technology similar to that used by credit card companies. Predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis and stop fraudulent claims before they are paid. Original Medicare claims will be analyzed using risk scoring technology that applies effective predictive models, an approach similar to that used by the private sector to successfully identify fraud.