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First, we had the HMO. Then came the PPO. These days, health care experts are buzzing about the ACO. That stands for accountable care organization, for those who haven’t yet heard about this small but growing concept. And if that describes you, it’s time to bone up, since there might be one coming soon to a doctor’s office near you. Like many changes going on in health care these days, ACOs are part of the Affordable Care Act, which creates incentives to encourage their wider use. The law included them in an effort to improve the treatment received by Medicare beneficiaries while also reducing costs. (Don’t stop reading if you’re under 65: many accountable care organizations also treat younger people who have commercial insurance.)
NPR - Shots
Medicare beneficiaries who win a settlement in a personal injury liability case sometimes find their efforts are for naught because the federal Centers for Medicare and Medicaid Services ends up getting the money they thought would be theirs. A new law is expected to fix problems with the system so seniors can get what's coming to them. The snafus arise in what's called the Medicare Secondary Payer process. If there's a settlement or judgment against another party in a liability case, Medicare is entitled to reimbursement for the money it spent on a beneficiary's medical care. It becomes the "secondary payer" while the liability insurer or other responsible party becomes the "primary payer."
Some accountable care organizations (ACO) are taking chronic condition management a step further by focusing on particular costly diseases. For example, Florida Blue (formerly Blue Cross and Blue Shield of Florida) and the Moffitt Cancer Center in Tampa, Fla., last month launched an ACO dedicated to cancer patients, American Medical News reported. And the Accountable Kidney Care Collaborative under DaVita, which acquired the group practice HealthCare Partners, will focus on kidney disease. "I would expect an increasing number of disease-specific accountable care ventures to develop over time," John Redding, manager at Indianapolis-based Blue Consulting Services, told amednews.
Kaiser Health News
Anyone who sues for personal injury probably knows that the process may take time. But for Medicare beneficiaries, too often it's not only the legal system that grinds slowly. Lawyers and policy experts say bureaucratic inefficiency at the federal Centers for Medicare & Medicaid Services (CMS) can add months or even years to the process. During that period, a beneficiary often must wait until Medicare is reimbursed for its costs before he or she can receive any payment. A new law that, among other things, spells out clear schedules for providing details about medical claims is expected to reduce those delays. The problem generally arises when a Medicare beneficiary believes he or she was harmed because of another party's negligence: getting hit by a car while crossing the street, for example, or suffering lasting injury because of a careless surgical error.