On June 1, 2023, the U.S. Supreme Court published their decision in two False Claims Act (FCA) lawsuits. The decision is one of the most significant developments for the FCA in recent history, as it resolves the necessary state of mind needed to violate the FCA. This Health Capital Topics article will discuss the FCA cases and the Supreme Court’s decision. (Read more...)
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On June 8, 2023, the Centers for Medicare and Medicaid Services (CMS) announced the establishment of Making Care Primary (MCP) Model, a voluntary primary care model that will be tested in Colorado, Massachusetts, Minnesota, New Mexico, North Carolina, New York, New Jersey, and Washington. Set to launch on July 1, 2024, the 10 ½ year model will seek to improve the coordination and management of care, enable primary care clinicians to form relationships with healthcare specialists, and form community-based connections to address the health needs of patients, as well as health-related social needs such as nutrition and housing. This Health Capital Topics article will discuss the new MCP Model and its implications for the healthcare industry. (Read more...)
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On June 14, 2023, CMS released health insurance enrollment and national health expenditure (NHE) projections for 2022 through 2031. The NHE, which is published annually, is the official U.S. estimate of insurance enrollment and health spending. CMS projects that from 2022 to 2031, the NHE’s annual growth rate of 5.4% will surpass the U.S. gross domestic product (GDP) annual growth rate of 4.6%. As a result, health spending as a share of the U.S. GDP is set to jump from 18.3% in 2021 to 19.6% in 2031. This Health Capital Topics article will review the notable findings from CMS’s projection report. (Read more...)
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As the U.S. healthcare system continues to shift its reimbursement scheme from traditional fee-for-service (FFS) payment to value-based alternative payment models, one value-based alternative payment model that has gained popularity since its establishment by the Patient Protection and Affordable Care Act (ACA) is the accountable care organization (ACO). In general, the ACO model holds groups of healthcare providers responsible for the quality and cost of healthcare delivery provided to an ACO’s patient population. The first installment in this five-part series will review the various types of ACOs. (Read more...)
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