FAQ on ACOs: Accountable Care Organizations, explained

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Accountable care organizations are practically a footnote in the health law, but advocates say they’ll be critical to holding down the cost of care while improving quality

By Jenny Gold
KHN Staff Writer
APR 16, 2014

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

A doctor walking through a mazeThe law takes a carrot-and-stick approach by encouraging the formation of Accountable Care Organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up.

An estimated 14 percent of the U.S. population is now being served by an ACO. You may even be in one and not know it.

While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.  

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work:  Continue reading

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Health news headlines — April 16th

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Patients often win if they appeal a denied health claim

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The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

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By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

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Focus one exchange enrollment overlooks millions who bought private insurance

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ACA health reform logoBy Annie Feidt, APRN

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that It had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. Continue reading

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Health news headlines — April 15th

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When naming unwise treatments, doctors overlook lucrative procedures

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Twenty-dollar bill in a pill bottleBy Jordan Rau
KHN Staff Writer

APR 14, 2014

This KHN story was produced in collaboration with the 

 

When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.

The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery.

The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline.

“They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don’t work or where they’re being done with no evidence,” said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University. “They chose stuff of no material consequence that nobody really does.” Continue reading

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Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

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Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

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Health news headlines — April 14th

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Doctors who shun insurance, offering care for cash

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200px-Flag-map_of_TexasBy Alexa Ura, The Texas Tribune
APR 11, 2014

This story was produced in partnership with 

LAREDO — For 12 hours a day, the waiting room at Dr. Gustavo Villarreal’s family practice is often packed with patients, people who will pay a flat $50 fee for the convenience — or necessity — of a walk-in, quick-turn doctor’s visit.

Villarreal’s practice, which does not accept any form of health insurance, has thrived despite its location in a city where nearly one-third of the population lives below the federal poverty line. Continue reading

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Health news headlines — April 12th

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Measles update: WA case count grows to 12, extending to third county

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Kitsap County resident confirmed with measles; exposure likely in San Juan County

 

From the Washington State Department of Health:

Alert IconApril 11, 2014 - Measles continues to spread in Washington as cases in San Juan County have extended to a Kitsap County resident. A man in his 40s from Kitsap visited several places in Friday Harbor, including a restaurant where a contagious San Juan County man was at the same time.

San Juan County’s case count is now five, and Kitsap County has one. In Whatcom County, the case count remains at six.  Continue reading

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