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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.
Unlocking Access: Exploring Mental Health Care Among Medicaid Managed Care Enrollees
January 23rd 2025On this episode of Managed Care Cast, we speak with the author of a study published in the January 2025 issue of The American Journal of Managed Care® to examine the association between quantitative network adequacy standards and mental health care access among adult Medicaid enrollees.
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