More than half of all state Medicaid programs incorporate a financial incentive encouraging providers to deliver better quality care, according to a study by the Commonwealth Fund. In addition, the study finds that 70% of existing Medicaid P4P programs operate in managed care or primary care management environments. Nine Medicaid programs are joining with other payers, employers and providers in statewide or regional P4P efforts, which is an indicator that the Medicaid plans are keeping pace with HMOs—half of which are offering P4P programs of their own.
Experts say that 5% of all claims are fraudulent or abusive. If the total spent on U.S. healthcare annually is approaching $2 trillion, that 5% would add up to nearly $100 billion a year in fraudulent or abusive claims. And the percentage may be higher, perhaps as high as 10% of claims.
If managed care executives can't get accurate information and honest opinions, they can't make the right decisions, according to Allan Baumgarten, author of annual state managed care reviews and an independent research consultant in policy, finance and local market strategies.
Health IT implementation slows down: Lack of legislation, standards stymie adoption of e-health records, e-prescribing systems
The long-sought national interoperable health information system remains far from reality as standards prove difficult to establish, provider uptake goes slowly and privacy concerns continue. A year ago, there were high expectations that Congress would adopt legislation supporting the creation of standards for electronic health records (EHRs). That bill faltered over disagreements about anti-kickback language and new billing codes.
Concrete details have more influence: Massive healthcare reform looks good on TV, but one-piece plans work better in real life
Typically not a big fan of movies, I was surprised by how much I enjoyed my DVD rental of "Man of the Year." The basic premise of the movie has a quirky, independent-party candidate winning the popular vote in a presidential race.
A number of cost-evaluation studies have emerged showing consumer-directed health plan (CDHP) members use less care. Meanwhile, others suggest that members are less satisfied with these plans and that they tend to choose unwise ways of saving money, such as skipping preventive care.