MedCity News June 19, 2024
Key questions that must be answered
One increasingly subtle but important theme in US healthcare is the shift to care allocated by payers rather than providers. Historically, decisions on what care to provide patients were made by physicians and hospitals – payer interventions were rare. Today that landscape is much different. The entire design of Medicare Advantage (now covering over 50% of Medicare patients) and managed Medicaid is to have payers manage care actively rather than simply paying for claims submitted by providers.
Over the years health maintenance organizations have emerged, with the most notable example being Kaiser. At Kaiser, allocation of care was really more of a joint decision with providers heavily involved. Today, while some Medicare Advantage...
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