Cooperating for better care.

Tricare

Tag Archives

VA mulls merging health system with Pentagon’s

The Department of Veterans Affairs is exploring merging its health system with the Pentagon’s,  in an apparent effort to get more vets into private-sector healthcare in order to save money. But veterans groups oppose such a plan, saying that it could threaten the economic and administrative viability of VA hospitals and clinics.

The merger would amount to merging the VA’s Choice and the military’s TRICARE private healthcare programs.

VA spokesman Curt Cashour told the Associated Press that the move  “provide better care for veterans at a lower cost,” but four of the largest veterans groups—the American Legion, Veterans of Foreign Wars, AMVETS and Disabled American Veterans—oppose such a merger.

“VA is a healthcare provider and the VFW would oppose any effort to erode the system specifically created to serve the healthcare needs of our nation’s veterans by reducing VA’s role to a payer of care for veterans,” Bob Wallace, executive director of VFW’s Washington office, told the AP.

Mr. Cashour, for his part,  said that the merger idea reflects President  Trump’s  “businesslike, commonsense approach that rarely exists in Washington” and that such thinking is needed to transform how the federal government does business.

The VA  said last May that it may show more than 1,100 facilities in order to move more care into the private sector. Its Choice program has also been extended, letting vets who may not have nearby access to a VA facility to see private providers instead.

To read all the AP report, please hit this link.

To read a FierceHealthcare report on this, please hit this link.

 

 

 


Testing value-based insurance for people in military

tricare

The  defense bill  signed last week by President Obama includes a pilot program to test value-based insurance coverage in Tricare, the U.S. Defense Department’s health-benefits program.

A provision in the bill calls for a program to  reduce or end co-pays and other cost-sharing for some drugs and services  that are considered high quality because they offer proven results — as in evidence-based medicine. Providers considered high-value would be reimbursed at higher rates as well.

The next defense secretary must submit a report within the next six months detailing which providers, services and medications will be considered high value and identify the co-pays or  other cost-share amounts to be reduced or eliminated when Tricare patients choose high-value care.

Modern Healthcare reported: “If the pilot results in people with certain conditions, such as heart disease and diabetes, having better outcomes, reduced emergency room visits or hospitalizations, and enhanced care, it may be rolled out to the entire Tricare population, according to a press release.”

Tricare provides healthcare coverage to about 9.4 million people in the military, retirees and their families. In 2015, the Defense Department spent $48.7 billion on healthcare services through Tricare.

To read more, please hit this link.

 

 


The big get bigger

bigfish

Aetna’s planned  $37 billion purchase of rival  Humana, which would make Aetna the biggest health insurer, would accelerate the consolidation of health systems as hospitals seek more leverage in negotiating with insurers  whose increasing size gives them vast negotiating power.

The deal would make Aetna a major player in the surging Medicare Advantage business and  would bolster Aetna’s presence in   Medicaid and in Tricare coverage for military personnel and their families. But everyone in the healthcare sector  would be affected,  directly or indirectly, including Federally Qualified Health Centers.
Modern Healthcare noted that Aetna’s  announcement came  a day after the Medicaid coverage provider Centene said it would buy fellow insurer Health Net to  help Centene expand in  the California Medicaid market, the nation’s biggest, and give it a Medicare presence in several other western states.
As private-sector-employer-based insurance has shrunken, the big insurers are  expanding into public programs at an ever faster clip.

 

 

 

 


Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass