CMS Proposes Major Update to Medicaid Managed Care Regulations

The Centers for Medicare and Medicaid Services released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations . The number of individuals enrolled in Medicaid managed care plans has increased to over 40 million .

SOURCE: Health Insurance News – Read entire story here.

Hospital Closures Had No Measurable Impact On Local Hospitalization Rates Or Mortality Rates, 2003-11 [Access To Care] The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was...
America’s Biggest Health Insurance Providers SOURCE: Forbes – Health – Read entire story here....
California Hospital Networks Are Narrower In Marketplace Than In Commercial Plans, But Access And Quality Are Similar [Exchange Coverage] Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers’ access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer these questions, we analyzed differences in hospital networks across similar plan types offered both in the Marketplace and commercially, by region and insurer. We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to...
Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units [Improving Care Systems] Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City’s Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening...
How Much Does A Colonoscopy Cost In California? Help Find Out The colonoscopy: It may be the most dreaded screening test out there, and it's the next step in KQED's PriceCheck project. On PriceCheck , we're crowdsourcing prices of common health tests and procedures....