Health Systems Report Financial Strength
Large health systems are on the upswing financially right now, with improved margins, higher volumes, investment returns, technology-driven efficiency, and better cash flow. In addition to the positives cited, health systems are also investing in alternative revenue streams, such as specialty pharmacy and outpatient care.
But storm clouds are moving in. Pharmaceutical and supply costs have posted sharp increases. And health systems face financial hits from the Medicaid and Exchange cuts in the One Big Beautiful Bill Act (OBBBA).
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#hospitals #margins #obbba
https://www.modernhealthcare.com/providers/mh-health-system-earnings-kaiser-mayo-clinic
Health Affairs Forefront Blogs On ACOs and ACCESS
Health Affairs Forefront has published a number of blogs on Accountable Care Organizations (ACOs) and the Medicare tech-enabled chronic disease ACCESS model.
In one blog, the main question is: “Do ACOs actually save Medicare money?” It notes that the Congressional Budget Office (CBO) has concluded, on average, they do not under the current design. But the authors say the Centers for Medicare and Medicare Services (CMS) have achieved a positive outcome in identifying clinician-led organizations that are willing to take responsibility for the beneficiary’s total cost of care. These organizations, however, may already have been more efficient. The authors encourage a consumer-oriented approach and harnessing competition among provider-led organizations to generate ongoing pressure for increased efficiency.
Another blog notes the sunset of the ACO REACH program in favor of ACO LEAD. LEAD will focus on improving care coordination for high-need beneficiaries (such as dual eligibles) rather than centering on equity-specific adjustments. LEAD emphasizes flexibility in payment design, a longer time horizon, and opportunities for state-level planning to align care for Medicare and Medicaid beneficiaries.
The last blog looks at ACCESS. It is highly critical, arguing organizations will emphasize “metric engineering” vs. care delivery and improvement. It says ACCESS bails out digital health companies, fragments primary care coordination for token payments, and will lead to cherry-picking. The views are decidedly negative and do not recognize the value of technology in monitoring and controlling co-morbidities.
Additional articles: https://www.healthaffairs.org/content/forefront/new-cms-aco-model-lead-better-care-high-need-medicare-beneficiaries and https://www.healthaffairs.org/content/forefront/medicare-s-unrealized-opportunity-using-acos-create-real-competition
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#medicare #acos #access
— Marc S. Ryan
