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Commercial health plans are betting that private health insurance exchanges can out-compete public ones for most employer-sponsored coverage.
Like other small businesses, physicians offices could be wooed by health plans and other groups running private exchanges. It also may mean that state-based exchanges won't be the only choice for uninsured patients looking for coverage in 2014 and beyond.
Generally, there are two types of private exchanges: one kind that allows a consumer to choose from a variety of types of health coverage from one company, and the kind that gives a choice of plans from several companies. Shoppers may be using their own money or spending a set amount from their employer. A health plan might host the exchange on its website, or an independent company may host the exchange and deal with collecting premiums.
Large insurers have invested in private exchange start-ups with the idea that they can offer a better insurance marketplace for employers and workers ...
Most hospitals say the Centers for Medicare & Medicaid Services' no-pay policy for hospital-acquired conditions has pushed them to make greater efforts to prevent health care-associated infections. But a study says preventing one item on the no-pay policy has gotten less of a push: catheter-associated urinary tract infections.
Nearly all hospitals have implemented practices aimed at reducing the incidence of central-line associated bloodstream infections and ventilator-associated pneumonia, says a study published online Dec. 6, 2011, in the Journal of General Internal Medicine. But less than half of hospitals are taking similar action against the nosocomial infection patients are likeliest to contract -- a urinary tract infection associated with the use of indwelling urinary catheters.
"Urinary tract infection is the Rodney Dangerfield of health care-associated infections because it gets no respect, even though it's the most common," said Sanjay Saint, MD, MPH, professor of inter ...
Federal health officials selected 32 health care systems, including several led by physician groups, to take part in the new Medicare pioneer accountable care organization initiative.
The Dept. of Health and Human Services estimates that $1.1 billion in savings could be realized from the ACO model, which encourages physicians and hospitals to coordinate care and offers shared savings for keeping patients healthy. Pioneer ACOs also face penalties when health care costs exceed projections. The pioneer ACO model was designed for health care groups with experience in providing patient-centered care.
The pioneer program, which begins on Jan. 1, 2012, is separate from the system-wide ACO shared savings program that was finalized in October. "We know that health care providers are at different stages in their work to improve care and reduce costs," said Marilyn Tavenner, acting Centers for Medicare & Medicaid Services administrator. "That's why we've developed a menu of options for Medi ...