CMS and AHIP Release Quality Metrics to Align Public and Private Payers

CMS released its first set of core quality healthcare measures intended to align quality improvement efforts across public and private payers with broadly agreed upon measures in seven categories: accountable care organizations, patient centered medical homes, and primary care; cardiology; gastroenterology; HIV and hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics. The measures were developed by the Core Quality Measures Collaborative, a group representing CMS, America's Health Insurance Plans, the National Quality Forum, physician groups and other stakeholders. CMS intends to implement the quality measures in Medicare as appropriate and will work with the Office of Personnel Management, the Department of Defense, the Department of Veterans Affairs and state Medicaid agencies to do the same. According to CMS, commercial health plans have committed to implementing the core set of measures as part of their contract cycles. The Collaborative will monitor usage of the measures, modify existing measures, and select new measures as needed.

Louisiana: Analysis Estimates Millions in Medicaid Managed Care Savings

An analysis performed by an independent reviewer and paid for by Louisiana's five participating Medicaid managed care organizations (MCOs) found that the managed care program saved between $250 million and $437 million in Medicaid expenditures in 2015 compared to what costs would have been for the same members under a fee-for-service model. The estimated savings were determined by comparing the MCOs' 2015 capitation rates to a range of fee-for-service spending forecasts for the same period. The savings represent 6.7% to 11.2% of estimated fee-for-service costs.