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In this issue
Accountable Care Organizations Series
  When analyzing this new aspect of healthcare, there is a proverb to keep in mind,

            “I KEEP six honest serving-men
            (They taught me all I knew);
            Their names are What and Why and When
            And How and Where and Who.”1

Under the Patient Protection and Accountable Care Act, Accountable Care Organizations (ACOs) were touted as the new redeemer of the American healthcare industry, promising to lower costs and increase quality for patients and providers. Within the context of these challenging expectations, significant questions have arisen among key industry stakeholders. Health Capital Topics’ new series will explore questions surrounding ACOs within the framework of Kipling’s proverb, i.e. why, what, who, where, when, and how.

PDF Icon Small Accountable Care Organizations Series: What Are ACOs?
The Medicare Shared Savings Program, an important Medicare delivery system reform initiative, constitutes a new approach to the delivery of healthcare with the three-part aim of: “(1) better care for individuals; (2) better health for populations; and (3) lower growth in expenditures.” Section 3022 of the ACA directs the Secretary of Health and Human Services to create the Medicare Shared Savings Program by January 1, 2012, and is intended to encourage the development of Accountable Care Organizations (ACOs) in Medicare. In this second part of the Accountable Care Organizations Series, this article considers the question: What Are ACOs? (Read more...)

PDF Icon CMS Bars Medicaid Payments For Preventable Conditions
Beginning on July 1, 2011, CMS will deny all Medicaid reimbursement requests associated with provider–preventable conditions, known as never events, reflecting a recent trend of payment policies aimed at lowering healthcare costs and increasing quality. The final rule, published June 6, 2011, implements Section 2702 of the ACA, and gives states one year to amend their individual Medicaid legislation for compliance. (Read more...)

PDF Icon Insurer-Run Care Expanding Into Retail Clinics
Insurer-owned health clinics are regaining prevalence across the U.S., with more than 1,200 retail clinics appearing at former urgent care centers, strip malls, and even in some grocery store chains. These clinics appeal both to patients, who are drawn to flexible scheduling, extended hours, urgent care services, as well as insurers attracted to potential financial and marketing benefits. Despite this resurgence, the ultimate role of retail clinics in the healthcare system remains to be seen. (Read more...)

PDF Icon Vermont Adopts Single-Payor System
In May 2011, Vermont Governor Peter Shumlin signed into law bill H.202, “An Act Relating to a Universal and Unified Health System,” laying the foundation for the first statewide, single-payor healthcare system. Green Mountain Care will be funded by Vermonters’ tax revenue instead of private insurance copayments or premiums. The legislation aims to control soaring healthcare costs while improving access to care. (Read more...)

1 “The Elephant’s Child” By Rudyard Kipling, Just So Stories, New York, NY: Garden City, 1912.

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