In the late 1990s, the idea of a disaster preparedness strategy hardly registered for most of the nation's hospitals, but today more and more are coordinating individual and regional strategies. Hospitals in those communities where disasters have previously occurred are the most likely to have ongoing disaster preparedness plans in place.
Medicaid Enrolees who suffer from expensive, chronic conditions tend to suffer from so many comorbidities and complicating social problems—such as homelessness and lack of transportation—that isolating a single disease state for intervention is ineffective. And states are beginning to recognize that.
The False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye-popping $900 million dollar settlement with Tenet Healthcare—the largest FCA recovery ever. And, as if these staggering numbers were not enough to garner attention, as of January 1, 2006, entities that receive $5 million or more per year in Medicaid payments will be required to inform their employees about the FCA. Because employees are the most likely whistleblowers in an FCA lawsuit, the FCA's prominence in the healthcare industry should increase over the next few years.
Washington, D.C.—As members of Congress headed out of town for the holidays in December, they managed to push through legislation containing a number of important policy initiatives for health plans and payers. A major tax bill delivered a reprieve for doctors from planned Medicare rate cuts. The bill freezes Medicare fees to physicians for one year, which could lead to an even bigger cut in 2008. It also offers a small bonus to those doctors who comply with quality reporting requirements. And to further bolster pay-for-performance initiatives, the legislation calls for hospitals and clinics to report on quality measures.
Just like the rest of healthcare, dental and vision ancillary benefit providers are adopting cost-sharing strategies that offer options to employees but demand more skin in the game. With less financial responsibility on the shoulders of employers, ancillary benefits have become more flexible, varied and are more closely tied to the overall health of individuals, who are assuming more risk for their health.
According to Greek legend, a poor peasant named Gordius became the king of the Asian country of Phrygia because of a rather vague prophecy. An oracle had prophesied that the nation’s future ruler would come riding into town on a wagon, so when Gordius and his wife arrived in the public square driving an ox cart, the populace named him king.
Systems integration has evolved to become much more than a technology issue
Every state will be forced to implement Medicaid cost-containment strategies in 2004.
Health plans are going to look a lot different in the future, and the transformation needs to begin today.
Individual people and circumstances have different needs, and MCOs need to be flexible enough to meet them all