Thursday, February 03, 2011

Thursday Miscellany

Business Insurance reports that the Virginia Attorney General plans to ask the U.S. Supreme Court to review the federal  District Court's decision holding the Affordable Care Act's individual mandate unconstitutional without taking the time for an intermediate appeal to the 4th Circuit. Ultimately the Supreme Court will decide this issue but my best guess is that the Supreme Court will allow the Circuit Courts of Appeal to weigh in fiirst.

AHIP Hi-Wire reports on the House hearings about the Affordable Care Act held on January 26 and the slew of Affordable Care Act related bills that already have been introduced in Congress. Among them is the following
Rep. Darrell Issa (R-CA) introduced a bill (H.R. 429) proposing to repeal the health reform law and establish a program administered by the Office of Personnel Management to offer federal employee health benefits plans to individuals who are not federal employees
Mr. Issa is the chairman of the House committee with FEHBP oversight responsibility.

Inside Health Reform via AHIP HI-Wire reports that at a recent Brookings Institution meeting CMS Administrator Donald Berwick announced that CMS soon will release a proposed rule on the new "accountable care organization" concept and unveil ACO demonstrations to include Medicare beneficiaries and private payer plan participants. According to the article, "CMS is talking to private payers about public-private partnerships and about how clinically integrated organizations can align what they are doing for patients with private insurance with the goals of ACOs, Berwick told reporters after his presentation. (The Federal Trade Commission has warned that broad-based ACOs involving private payers could raise antitrust concerns, but the FTC has been working out those matters with CMS.)"

AIS reports that "Several Blue Cross and Blue Shield plans are moving forward on patient-centered medical home (PCMH) development and starting discussions with providers about accountable care organization (ACO) formation. And a handful of Blues plans actually have ACO pilots in operation."  The article surveys these efforts.

BlueCross BlueShield of Tennessee is typical of the plans that are closely watching what’s going on in the ACO space. “At this point, BCBST is looking at the market and proceeding slowly regarding ACOs,” says Tom Lundquist, M.D., vice president of performance measurement and improvement. “There’s a lot of talk about ACOs, and some provider groups and hospitals have said they’re interested in having discussions.” Trouble is, he adds, “some [of the providers] believe they’re ready to become an ACO without really discussing the finer points. We’re still not sure what the definition is, so we’re waiting for ACOs to be fully defined.”

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