Fake Doctor Roams Boston Hospital

Gretchen Jacobson
Kaiser Family Foundation

Well, they have defied expectations so far. It had been anticipated that MA registration would decrease from 10.9 million enrollees (or 24% of all Medicare registration) to 8.2 million (15 percent of Medicare’s total registration). Enrollment has continued to rise. In 2016, 17.6 million Medicare beneficiaries–or 31% of all beneficiaries–were MA plans.

April Kunze
Prime Therapeutics

However you slice it, 2016 was a banner season for biosimilars. Still, the high-stakes advertising, regulatory, and authorized combat between originators and biosimilars is a very long way from over. Thus far, the originators have managed to hold their ground and also thwart the launch of biosimilars.

The measures used to evaluate care quality are process measures. Outcomes, obviously, are harder to measure than whether a certain action was taken–checking a patient’s feet with diabetes, for example. But specialists don’t think procedure measures get in the core of quality.

The problem, a few analysts and say hospitals, is that rating hospital grade isn’t too straightforward. The way the bicycle delivers care is complex and multifactorial, they assert, so attempting to cram that into a single score can end up like rating a restaurant on its parking and is ineffective.

After 25 decades, the Healthcare Effectiveness Data and Information Set (HEDIS) is still criticized for focusing on procedure and carrying up doctors’ time. But it has been incorporated into doctors’ workflow and may yet be instrumental in bringing about value-based care.

If insurers insist that older drugs are used by doctors first, the weight will be on the health plan to react to doctors’ petition for unique medications nimbly, and suitably. But fast and nimble do not clarify insurers’ attempts.

The certainty seemed to be lots of uncertainty. A number of the assumptions concerning the market that companies, providers, and insurance executives use to create firm decisions no longer employ. “We started with a new piece of paper yesterday,” Aetna CEO Mark Bertolini said in a conference on health care sponsored by the New York Times.

Since their clout has grown, so has the examination on these. For instance, the Department of Justice and U.S. attorneys for the Southern District of New York and Massachusetts are starting to research the business’s pricing arrangements, client payment strategies, and individual assistance programs.