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Dual-eligibles market creates opportunities for physician practices

Physicians have new opportunities to partner with health plans to take advantage of the rapidly growing private market for beneficiaries who are eligible for both Medicare and Medicaid, according to a partner at a global management consulting firm. “There’s been a tremendous interest and appetite around the so-called dual-eligibles population,” said Sanjay Saxena, MD, a partner in the North American health practice at Booz & Co. and co-author of a new Booz report. Several years ago, discussions about changes in the private insurance market were all about health insurance exchanges, then about accountable care organizations, and “now it’s about the duals,” Dr. Saxena said. The Booz report discusses ways in which managed care companies could leverage both the Medicaid and dual-eligibles markets by identifying states that present the best growth opportunities and then defining their operating models or “choosing a way to play” in these markets. Managed care organi ...

Health is improving for U.S. adults with HIV

Significant health improvements have been made among HIV-infected adults in the United States, according to a study in the Sept. 4 issue of Annals of Internal Medicine. Those advancements include an increase in the proportion of people taking highly active anti-retroviral therapy, researchers said. The treatment consists of using at least three drugs to maximally suppress the HIV virus and stop progression of the disease. In 2008, 83% of HIV-infected adults who received care were prescribed the therapy, up from 74% in 2000. “This is good news for the HIV epidemic in the U.S., but there is room for improvement,” said lead author Keri N. Althoff, PhD, MPH. “We need to continue to focus on linking HIV-infected adults into care and effective treatment, not only for the individual’s health, but to reduce the likelihood of transmission to others,” said Althoff, an assistant professor in the Dept. of Epidemiology at Johns Hopkins Bloomberg School of Public Health in Mary ...

AMA details multipronged approach to Medicare pay overhaul

The outdated Medicare payment system needs to offer more options for physicians when lawmakers craft reforms, the American Medical Association stated in an Aug. 30 letter to the Senate Finance Committee. Sen. Max Baucus (D, Mont.), the committee’s chair, had asked the AMA and other physician organizations to offer suggestions on how to transition to a new payment system after a July 11 roundtable discussion with organized medicine and committee members. During that hearing, senators agreed that the current system is broken and that the sustainable growth rate formula used to help calculate Medicare rates in the fee-for-service system needs to be replaced. The SGR is set to reduce rates by about 27% in 2013. A new pay system would need to be a significant departure from the current one-size-fits-all program, wrote AMA President-elect Ardis Dee Hoven, MD. It would need to promote delivery models that reward quality of care instead of simply volume of services provided. “As s ...