State, insurers base payments on value amid rising healthcare costs

Ohio is planning to implement a public- and private-sector partnership to cut healthcare costs in the Medicaid program and the private insurance market, according to The Columbus Dispatch. The state aims to have 90 percent of its population covered by insurance emphasizing value over volume within five years. 

With a $3 million federal grant authorized by the Affordable Care Act, Ohio officials are working with Aetna, Anthem Blue Cross and Blue Shield in Ohio, CareSource, Medical Mutual of Ohio and United Healthcare to launch the new program next year. 

The program will initially focus on using primary care doctors to coordinate healthcare and designing new ways to pay for five high-cost "episodes," including joint replacement and certain treatments of asthma and chronic obstructive pulmonary disease.

Primary care providers have expressed concern about effects of healthcare reform on their practices; but under Ohio's program, primary care doctors will get bonuses when they oversee all their patients' care, use electronic health records for all patients, provide 24/7 access to their practice, adopt disease-management protocols and track hospitalized patients.

Ohio's initiative comes in the wake of reports predicting healthcare costs will rise for employees and small businesses after healthcare reform: Consultants predict a 4.8 percent to 6.7 percent increase in the cost of health benefits per employee nationwide, the Dispatch noted.

Moreover, two-thirds of small businesses report paying more for insurance premiums per employee this year than they did in 2012, according to a study from the National Federation of Independent Business, reported The Washington Times

And many employers are trimming their healthcare benefits and transferring costs to workers, reported The Tennessean. During the next four years, 69 percent of employers plan to shift more healthcare costs onto employees by eliminating no-longer-required benefits such as spousal coverage, The Tennessean noted.

For more:
- read the Columbus Dispatch article
-  see the article in The Tennessean
-  read the Washington Times article

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Hospitals still torn between volume and value equations
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