It’s Time to Tame the “Diagnostic-Coding Arms Race”: NEJM Opinion Piece

July 29, 2022

The trend of primary care practices and businesses bearing risk has pitfalls. A trio of experts have suggestions for how they can be avoided, including taking steps to de-emphasizing diagnostic coding in the calculations that determine payment.

Another Legal Challenge to the ACA

July 26, 2022

The plaintiffs in Kelley v. Becerra are arguing that the Affordable Care Act’s requirement that preventive services be covered without cost sharing is unconstitutional. In a factsheet published yesterday, the Urban Institute says that the ACA requirement has had an especially a large effect on women, partly because contraception is among the services covered by the no-cost-sharing rules that apply to private insurers.

Why Social Determinants of Health Are a Critical Factor for Preventing Member Risk Escalation in the Value-Based Care Equation

June 27, 2022

Medicaid managed care organization (MCOs) may be better equipped to address social determinants of health (SDOH) and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination.

Biden's Proposal to Lower Medicare Eligibility to 60: Winners and Losers

November 16, 2020

Some employers would benefit if their older employees go on Medicare, and people in their 60s would have some safety net if they can't find a job with benefits. Provider revenues might take a hit because of lower Medicare reimbursement.