Cartoon – Madame Zorba
Monthly Archives: September 2016
Cartoon – Mergers Today
Chinese billionaire ups stake in CHS for $31.9M
http://www.beckershospitalreview.com/finance/chinese-billionaire-ups-stake-in-chs-for-31-9m.html
Chinese billionaire Tianqiao Chen has a more than 12.9 percent stake in Community Health Systems after recently buying nearly 3.5 million more shares of the Franklin, Tenn.-based for-profit hospital operator, according to a recent Securities and Exchange Commission filing.
Mr. Chen and his group of companies paid just over $9 on average per share, bringing the total price of the transaction to $31.94 million.
A pioneer in China’s online gaming industry, Mr. Chen’s net worth is estimated by Forbes to be at more than $1 billion.
Mr. Chen, who began buying CHS at the end of the second quarter, upped his stake in the company as it is exploring options with financial sponsors. Private equity firm Apollo Global Management is reportedly in discussions to acquire CHS’ assets. Some real estate investment trusts are also interested in the company’s assets, people familiar with the matter told Reuters.
Would You Like Some Insurance With Your Insurance?
Gap plans, used to cover out-of-pocket expenses like high deductibles, are becoming increasingly popular among consumers and businesses.
The rising price of insurance is driving the trend, explained insurance broker Ryan Hillenbrand, president of the Missouri Association of Health Underwriters.
“People see the prices of individual insurance and they say, ‘Boy, a $6,000 deductible seems really high. I don’t want something that gives me that much risk,’ ” Hillenbrand said. “That’s why [the gap insurance] market is heating up a little bit more.”
Gap insurance is in a category of insurance known as “limited benefit.” No matter how bad a person’s situation, the plan will pay out only a certain amount of money. “Mini-med” policies, now illegal under the Affordable Care Act, are another example of a limited benefit plan
Now, there’s renewed interest in gap plans. With monthly premiums on health insurance going up, more people are choosing cheaper, high-deductible options. In 2016, more than90 percent of people buying insurance under the ACA chose plans with an average deductible of $3,000 or higher.
Next year, the cost of one of the most popular plans available under the Affordable Care Act could increase by 10 percent on average across the country. That comes on top of a 5 percent jump the year before.
When consumers see those prices, Hillenbrand said, “they get sticker shock.”
“If you don’t qualify for a subsidy, you’re bearing the brunt of all that cost,” Hillenbrand said. “And here come the gap plans.”
The Opportunities and Challenges of the MSSP ACO Program: A Report From the Field
https://www.aledade.com/new-journal-article-a-report-from-the-field/
The trillion dollar shift in healthcare payment “from volume to value” is well underway with both public and private payers and purchasers pushing provider organizations to participate in outcome-based risk contracts, stepping up from pay-for-performance and medical home models to a variety of accountable care and bundled payment programs.
But what are we to take away from the mixed results of these programs — from the lack of savings in the Comprehensive Primary Care demonstration, to the dropouts from the Pioneer program, the recently released underwhelming results from the first year of the Bundled Payment for Care Improvement Initiative, or the 2015 results from the Medicare Shared Savings Program?
One approach would be for partisans for each of these approaches to search for positive nuggets in the results from their preferred program, while heaping scorn on the other “competing” reforms.
Another would be to retreat altogether from the aspirations of achieving better care at lower cost, towards either resignation towards ever-escalating health care costs or more likely to (altogether regretful!) rationing of access to good healthcare for the most vulnerable in our society.
A third path would be to acknowledge that there is no magic bullet for “transforming healthcare” overnight, and that the work of redesigning our delivery systems to meet the expectations of the outcome-based payment models will be slow, hard, and uneven. We would accept that there are likely multiple payment reforms that will need to be implemented alongside each other, targeting different healthcare markets and different participants. (Capitated payments for truly integrated delivery networks. Mandatory bundled payments for proceduralists and hospitals. Accountable care for independent physician networks). And each model will need to be iterated and tweaked and incrementally improved.
That is what I choose to believe.
We are publishing today in the new issue of the American Journal of Managed Care, “A Report From the Field,” the detailed description of what our two ACO “freshman” accomplished in 2015, and openly discussing the challenges we faced, what we are doing differently now, and some policy changes that can put more wind to the backs of those in these trenches.
Here are a few of the key findings:
Conclusions:
We have learned that, given the right support and incentives, independent primary care practices can embrace population health and practice redesign. These efforts can begin to bear fruit in improved patient access, quality of care, and appropriate utilization in the short term. We strongly believe that the benefits of the program to patients and the taxpayer are not limited to those ACOs that received shared savings distributions. However, lack of recognition of these contributions may stifle continued innovation and physician engagement with alternative payment models. Aledade is committed to navigating these challenges and we are committed to sharing our learning so that more independent physician-led ACOs can succeed in their mission to profitably deliver better care at lower cost. We also hope that policy makers and commercial payers continue to work to remove the unintended policy headwinds ACOs must presently overcome. – See more at: http://www.ajmc.com/journals/issue/2016/2016-vol22-n9/the-opportunities-and-challenges-of-the-mssp-aco-program-a-report-from-the-field/P-5#sthash.3V1BtAtZ.dpuf
ACO inside report details challenges of ‘regulatory headwinds’
- A new report from Aledade, a company that helps physicians form and operate accountable care organizations (ACOs), says its groups have successfully increased primary care utilization and revenue, decreased lab and imaging costs, and decreased emergency department and hospital utilization and readmissions.
- The findings were shared to provide a “frontlines” perspective on the challenges and lessons learned in delivering value as a Medicare Shared Savings Program (MSSP) ACO.
- The report calls out “regulatory headwinds” that it says are currently working against ACOs in the program, including the national benchmark used to determine savings. Although the implementation of regional benchmarking will provide a more accurate measurement in years 4-9, in the meantime it still leaves some ACOs facing a longer stretch of time to achieve financial success.
AMA: Insurance megamergers ‘threaten healthcare access, quality and affordability’
- The merger of health insurance giants “would significantly compromise market competition in the health insurance industry and threaten health care access, quality and affordability,” the president of the AMA said as the group released new analyses of the mergers.
- In the analysis, the AMA claims the Anthem-Cigna merger would diminish competition in 121 metro areas across 14 states, and that the Aetna-Humana merger would diminish it in 51 metro areas across 15 states.
- The studies also note an “unprecedented lack of competition” that already exists in many states, the AMA says.
http://www.ama-assn.org/ama/pub/news/news/2016/2016-09-21-ama-analyses-support-blocking-mergers.page
Microsoft wades into healthcare R&D. What’s behind this trend?
- Microsoft is engaged in numerous health research projects in a mutually beneficial relationship with the medical community, according to an article on the Microsoft website.
- One Microsoft project is using machine learning to sift through massive amounts of data on cancer biology to make precision medicine more possible. Another is a cloud-based tool that creates computerized models of biological processes associated with cancer progression.
- Microsoft’s excursion into medical research is just one of many made in the recent past by technology companies not typically associated with healthcare.
Cartoon – A Song in your Heart
Cartoon – More Valuable Alive or Dead?
HENRY KOTULA 