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This Week in Managed Care: August 8, 2015
The top stories in managed care, including what providers really think about the use of quality metrics, readmission rates for Medicare patients, and preventing drug-resistant infections.
This week HHS found that competition among health plans in the Affordable Care Act’s insurance marketplaces helped consumers find the best prices. However, there are now concerns that if the mergers between Aetna and Humana, and Anthem and Cigna go through that they will decrease competition levels that led to better prices and premiums.
The use of quality metrics to assess providers’ performances is viewed negatively by primary care providers, along with financial penalties for unnecessary hospital admissions and readmissions. However, providers believe health information technology is having a positive impact on quality of care.
Under the Hospital Readmissions Reduction Program, 2592 hospitals will lose a combined $420 million dollars due to penalties as a result of their Medicare readmission rates. One in 5 Medicare patients is still readmitted to the hospital within 30 days of discharge.
Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending
August 19th 2025Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.
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Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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Care Quality Metrics in Medicare During COVID-19 Pandemic
August 12th 2025Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.
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