Forefront: How Startups And Medicaid Can Collaborate To Improve Patient
Outcomes
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Monday, February 27, 2023 | The Latest Research, Commentary, And News
From Health Affairs
Dear John,
Did you know that by becoming an Insider you can access all of our
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Private Versus Public Ambulances
In this month's issue, Loren Adler and coauthors examine the ownership
structure of ground ambulance organizations
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to compare pricing and billing between private- and public-sector
ambulances.
"Using commercial insurance claims, we found that 28 percent of
emergency transports and 26 percent of nonemergency transports resulted
in a potential out-of-network surprise bill," the authors report.
The authors find that being transported by a private-sector ambulance in
an emergency is associated with substantially higher allowed amounts,
patient cost sharing, and potential surprise bills compared with being
transported by a public-sector ambulance.
These findings highlight substantial patient liability and important
differences in pricing and billing patterns between public- and
private-sector ground ambulance organizations.
This research is especially interesting given the current
surprise-billing policy landscape.
The federal No Surprises Act, which took effect in January 2022, bans
surprise billing for those with commercial insurance in most situations
where patients cannot choose their clinician or service provider.
However, the legislation omitted ground ambulance transports.
Read More
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Elsewhere At Health Affairs
Today in Forefront, Justin Norden and coauthors discuss learnings from
Medicare Advantage and outline four key opportunities for startups and
Medicaid plans
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to work together to better serve Medicaid populations.
Travis Williams and coauthors explain the 2023 final rule on Medicare
Advantage Risk Adjustment Data Validation (RADV) audits, examining how
the rule lets insurers keep billions in overpayments
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Health Affairs Branded Post:
Privacy by Design: Increasingly Important Approach to Healthcare Data
Risk Management
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Daily Digest
Ground Ambulance Billing And Prices Differ By Ownership Structure
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Loren Adler et al.
How Startups And Medicaid Can Collaborate To Improve Patient Outcomes
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Justin Norden et al.
Medicare Advantage Audit Changes Let Plans Keep Billions In Overpayments
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Travis C. Williams et al.
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