recent study of health care organizations showed that most are not prepared to deliver standardized longitudinal care across multiple provider systems. Shared care plans will be the centerpiece of coordinated care delivery, incentivized by the move from fee-for-service to value-based care. In 2015, Medicare unveiled its plan to transition to quality-based payments via the Merit-Based Incentive Payment System (MIPS), which will sunset and subsume earlier quality-encouraging programs, ...

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My friend Jeremy went to an emergency room with belly pain, and soon learned he'd been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his ...

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UnitedHealthcare (UHC), the nation’s largest health insurer, will likely pull out of Obamacare in 2017. Citing high costs and huge potential losses, they warned that 2016 will probably be their last year offering health insurance through the Obamacare exchanges. Is this another example of greedy insurance companies with fat cat CEOs gouging the system? Or are economic realities interfering with the “hope and change” of Obamacare? UHC isn’t really selling insurance. Instead ...

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With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with ...

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After reading my latest post about conflicts of interest in health care, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful. Since hostility is never my goal, I thought I’d give it a try. I read for an entire evening on butterflies -- their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother ...

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Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society. Physicians have always been charged as patient agents to advocate for patients' best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often ...

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Health care providers and patients alike have been physically and emotionally frustrated when dealing with health care’s rising cost. Legislative restrictions based on cost often defy logic and common sense in a way that most people have never encountered. But what is it specifically about the health care market that gives us these fundamentally perverse situations? Many point fingers at insurance companies, big pharma, hospitals owned by private equity firms, ...

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If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000! That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit ...

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I cracked a Budweiser and flipped on Spotify radio for what I was told would be a challenge.  On my computer screen, Minnesota’s health insurance exchange website waited expectantly, to which I submitted the Holy Trinity of health information -- age, date of birth, and tobacco usage -- and waited.  The next page loaded slowly, evidence of the voluminous information that would soon surface.  I had hoped for simplicity, instead, ...

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The federal government is currently debating whether the big six health insurance companies in the U.S. will soon become the big four. Aetna and Humana have announced plans to merge, as have Anthem and Cigna. The American Hospital Association and the American Medical Association strongly oppose the mergers, saying they will reduce competition in consumer markets. Meanwhile, health care provider groups continue to consolidate. Small hospitals either get swallowed up by ...

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