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Commercial accountable care organization products: Market leaders and trends

In 2006, Elliott Fisher of Dartmouth coined the term “accountable care.” Accountable care arrangements are based on three principles: Accountability for quality: A group of providers is clinically and financially responsible for the entire continuum of care for a group of patients. Depending on the arrangement, providers, hospitals, and health insurers may share responsibility for the patients’ care. Shared savings: …

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Health care spending for chronic conditions in Michigan

Chronic conditions affect millions of Americans and have a major impact on U.S. health care spending each year, accounting for seven out of every ten deaths in the United States annually. It is estimated that more than 75 percent of all health care costs are associated with chronic diseases. Approximately 45 percent of Americans nationwide are affected by at least …

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Community mental health services: Coverage and delivery in Michigan

Since 1965, the number of Community Mental Health centers (CMHs) has increased from 12 covering 16 counties to 46 covering all 83 counties in Michigan. Today, Medicaid is the major source of most funding for the publicly funded mental health system in Michigan, and care at CMHs is an entitled benefit under Medicaid. As such, individuals with Medicaid coverage are …

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Autism spectrum disorder in Michigan

Autism spectrum disorder (ASD) comprises a group of developmental disabilities that cause impairment in social interactions, communication skills, and behaviors that can have long-term health and social functioning costs for individuals with ASD and their families. In 2014, the Centers for Disease Control and Prevention (CDC) reported that approximately one in 68 children in the United States were diagnosed with …

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The ACA and essential health benefits: Overview of new coverage standards in individual and small group markets

Beginning in January 2014, the Affordable Care Act (ACA) introduced a series of health insurance reforms, particularly for consumers purchasing coverage through the individual market or covered through employment at a small firm. One of the most prominent of these reforms is the requirement that all health plan products in certain market segments must cover an established set of essential …

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Effects of the ACA on insurance affordability for the uninsured in Michigan

January 1, 2014, marked the beginning of new health insurance affordability programs made available through the Patient Protection and Affordable Care Act (ACA). These programs include tax credits to lower premium costs, assistance to reduce out-of-pocket expenses, and an optional state expansion of Medicaid eligibility. This analysis examines the effects of the ACA’s premium tax credits and cost-sharing reductions on …

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ACA Health Insurance Marketplace: Michigan overview and operations

On March 31, 2014, the Affordable Care Act’s (ACA) Health Insurance Marketplace officially closed for most people until open enrollment begins for 2015 health plans on November 15, 2014. By the end of the first open enrollment period, 272,539 Michigan residents had signed up for a plan through the ACA marketplace. Assuming that many of these residents complete the enrollment …

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Pain-Related Care and the Affordable Care Act: Summary of Common Practices

This paper provides a brief overview of key findings in the Institute of Medicine (IOM) 2011 report on pain, how public and commercial insurers approach pain management, and the pain-related provisions in the 2010 Patient Protection and Affordable Care Act (ACA). The IOM released a report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, summarizing findings …

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An in-depth look at six cost containment programs in the Affordable Care Act

This paper describes six cost-containment policies or initiatives included in the Affordable Care Act (ACA) that target how health care is delivered and the growth of health care costs. A summary of the implementation occurring in Michigan is also provided. The policies or initiatives explored in depth here are: Accountable Care Organizations Hospital-Acquired Conditions Value-Based Purchasing Hospital Readmission Reductions Program …

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Cost containment in the Affordable Care Act: An overview of policies and savings

While there has been considerable media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been less discussion of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care expenditures. And yet, the elements included in the …

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