Medicare Advantage (MA) is an important source of health insurance coverage for Medicare beneficiaries; the number of enrolled beneficiaries has grown steadily since the early 2000s, with over one-third of Medicare beneficiaries (19 million individuals) enrolled in an MA plan in 2017. An MA organization is a private insurer that has contracted with the Centers […]

The Healthcare Information & Management Systems Society trade show, commonly known as HIMSS, is among the largest trade shows in the world, drawing more than 42,000 people looking for the latest innovations and emerging trends in health information technology. It’s so big, it can almost be overwhelming. But I did find two key takeaways during […]

The United States spends more on health care than all other developed countries, and costs are expected to continually rise. At the same time, greater spending hasn’t resulted in better health outcomes for patients, with the U.S. trailing other industrialized countries in health rankings. Recognizing that this pattern isn’t sustainable or effective, payers have spent […]

  This blog was originally published on The Medical Care Blog. The right care, for the right person, in the right place, at the right time. That’s a reasonable goal of a high-quality health system. In the US, however, many people go to the emergency department (ED) when a primary care provider (PCP), or perhaps an […]

Preterm birth, when an infant is born within the first 37 weeks of pregnancy, is a pressing public health problem both abroad and in the United States. At birth, preterm infants are not yet fully developed and usually are classified as having low birth weight, meaning they weigh less than 5.5 pounds (about 2,500 grams). […]

An estimated 72,000 Americans died due to drug overdose in 2017, with opioids responsible for over two-thirds of those deaths. Although the opioid crisis is clearly a problem, what is less clear is how to best confront the crisis with interventions that target specific groups of people and are also evidence-based. As a part of […]

Health care in the United States is frequently highlighted as the most expensive of anywhere in the world. An important, yet often overlooked, portion of these costs comes from administrative activities such as billing and processing of medical claims. Various studies over the past few decades have estimated that these costs range from 20% to […]

Direct Provider Contracting has been used for decades as a way for employers to arrange for specific health care providers to deliver a defined set of services (such as hip or knee replacement) to their employees at a discounted rate. This arrangement is markedly different than the standard approach of employers paying an insurance company […]

In late July of 2018, Blue Cross Blue Shield of North Carolina (BCBSNC) made an unexpected announcement: they will be lowering premiums on Affordable Care Act (ACA)-compliant health plans. Specifically, BCBSNC announced premiums would be on average 4% lower in 2019 than they were in 2018 for plans bought on the federal marketplace (an online […]

A July 2018 New York Times article reveals that nursing homes have been fudging the numbers on staffing. This article, supported by a Kaiser Health News analysis of data from the new payroll-based journal (PBJ) system, reported that 70% of nursing homes had lower staffing than previously thought. Mandated as part of the Affordable Care Act […]