In the News: Jun 21–28

States Try a New Medicaid Payment System

A recent Kaiser Health article highlights that states such as Minnesota are implementing new payment systems to alleviate financial issues arising from high-risk, high-utilization Medicaid patients—specifically, they are developing Medicaid accountable care organizations (ACOs) to address this unique population. Under the newly formed Medicaid ACOs, hospitals and physician care teams are rewarded for reducing costs and improving the overall health of plan enrollees. Approximately half of the state’s million Medicaid recipients partake in an ACO, which is estimated to have saved Minnesota $213 million since 2013. The shift to ACO plans poses challenges to health systems that now must work with patients to address social determinants of health, often administering preventive care in nontraditional sites of care.

Sg2 offers organizations the opportunity to assess readiness to engage in population health management strategies and appropriate avenues to meet community needs. To learn more, visit the Sg2 resource kit Population Health Management.

AMA Announces Opposition to Aetna and CVS Merger

The American Medical Association (AMA) recently announced its opposition to the proposed Aetna and CVS merger, citing concerns that the merger will reduce competition “to the detriment of patients.” AMA President Barbara McAneny noted potential costs for patients, including anticipated increases in drug spending, out-of-pocket costs and insurance premiums. CVS and Aetna argue that the merger will decrease costs for consumers.

Vertical integration of nontraditional players like Aetna and CVS has exploded over the last 6 months, with important implications for health systems. The merger and acquisition (M&A) activity targets opportunities to provide lower-acuity services (primary care, home health, post-acute care), which are often the front and back doors to the health system. To learn more about what this disruption could mean for your organization, read the Sg2 Expert Insight Vertical M&A in Health Care: What Does It Mean for Health Systems?

Health Systems Seek Digital Tools to Improve Patient Experience

Many health care organizations are currently focused on adopting digital technologies to address consumer-centric issues such as improving the patient experience and enhancing clinical outcomes. Nearly half of organizations who responded to a recent Ernst & Young survey planned on measuring and improving patience experience in the next year. Informed by survey data, health care organizations may provide patients with more digital agency to relieve some of the burden on providers who may be struggling with burnout.

Sg2 has been closely monitoring consumer technology trends, particularly as they relate to improving the patient journey. From retail clinics to virtual health, consumers have more options than ever when it comes to accessing care. Defending and gaining market share in this new consumer ecosystem demands that health systems better understand factors influencing consumer decision making and redesign offerings to be more responsive to consumer needs. To learn more about the new consumer ecosystem and the short list of fixes aimed at common consumer pain points, read the Sg2 report Reinventing the Patient Journey: A Consumerism Update and Outlook.

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