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Patients: Why is it SO HARD to find mental health care? Hospitals: Why do so many behavioral health crises land in my ER? Health plans:

One reason to doubt arguments that, instead of addressing moral hazard via value-based pymt, Medicare should “just stop paying for X,” is that these claims often don’t reckon with operational reality. Study here on what happens under Medicare prior auth. Both good and, well…👇

From a policy perspective, we’d be better off acknowledging that “supplemental benefits” under Medicare Advantage are just taxpayer-funded marketing gimmicks. If medical societies & hospitals are upset with MA plans, their lobbying muscle should focus on slashing these giveaways

Never forget that the AMA is a cartel.

Easy. Medicare has made health services less expensive than when those same services are purchased through a private insurer, while making coverage and payment more efficient than in the private sector, and the services themselves more readily available.

This is a healthy change from CMS Innovation Center. When conveners hold most or all financial risk, they unwind the incentives that CMS is trying to create. Same problem when MA plans do risk deals with IPAs, which then pay PCPs fee-for-service or a flat cap rate. Largely useless.

There are a number of studies suggesting that female physicians get better clinical outcomes. So, interesting to now see research finding that value-based payment converts those outcomes into potentially higher compensation for women PCPs. jamanetwork.com/journals/jama-…

The recent price cuts for GLP-1s are a great case study in how the third-party payor system contributes to high drug costs. Drugmakers typically launch new products at a “modestly high” price, desiring to avoid insurer resistance and encourage broad patient uptake. Once doctors

Using MA claims/Star rating data for 872 PCPs in 7 states who took on full risk for their MA patients, we found women PCPs had better quality outcomes and their patients had fewer ED visits and hospitalizations. Women earned the same per patient under FFS and *MORE* under VBP.

One way to look at societal affordability in healthcare? We made real headway on Medicare in the post-ACA decade (and a half)… …but we’ve made little or no progress for the majority of Americans and all the employers & entrepreneurs not protected by Medicare or Medicaid.

Interesting study, suggesting that employers in Colorado mountain towns lowered premiums by 13-17% by collectively negotiating lower provider prices. Perhaps a bit like Germany, which has private providers & plans but uniform regional fee schedules. onlinelibrary.wiley.com/doi/10.1111/jo…

Pretty clear The Wall Street Journal summary of concerns about vertically-integrated insurers (not just UHC!). The "provider" subsidiaries do depend on the parent insurer steering patients their way. And, what's not mentioned - the insurer obligating independent providers to contract with that sub

Helpful data on medical practice ownership. As shown elsewhere, hospital buyouts are a much bigger factor in consolidation, and the recent↗️in consolidation, than is private equity. And if insurers want a competitive provider landscape, they have to stop strangling independents