Managed care is an all-encompassing term that covers a variety of methods to pay for healthcare outside the norm of fee-for-service. Medicare Advantage (MA) plans are a form of managed care, as are Managed Medicaid plans. Accountable Care Organizations (ACOs) also fall under this umbrella. With the exception of MA, managed care is a relatively new idea in terms of health care financing. Generally, with managed care, payments flow through a risk-bearing third-party company to health care providers. The third party’s goal is to manage a patient’s total cost of care so that the total payment made by the third party is smaller than the initial bill. How this system is regulated is still evolving; CMS is committed to moving away from traditional fee-for-service payments, and managed care has a role to play in attaining that goal.
The burden of caring for a loved one has been in the news recently. Last year, AARP reported that in 2013, an estimated 40 million people acted as caregivers, assisting with at least one activity of daily living (ADL) and providing $470 billion in uncompensated care over 37 billion hours. That’s a sum greater than Belgium’s GDP in 2015. In fact, the total value of uncompensated care exceeded the total Medicare spend in that year by over $20 billion. And these figures don’t even begin to touch upon the emotional price of being a caregiver.
All Medicare-certified skilled nursing facilities are subject to the Five-Star Quality Rating System and Nursing Home Compare, which were established, implemented, and maintained by the Centers for Medicare and Medicaid (CMS). Both programs use metrics to judge the quality of skilled nursing properties. Nursing Home Compare is a website where consumers can gather information about quality metrics for every eligible skilled nursing property to use for comparison shopping. Most of the quality metrics displayed on Nursing Home Compare are used as part of the input to establish a skilled nursing property’s Five-Star rating, with five-star facilities considered the highest quality.
The second quarter 2016 data release marks another milestone for NIC and the NIC MAP® Data Service. With this release, we’re excited to officially launch our coverage of 41 additional metropolitan markets. The Additional Markets expand NIC MAP’s coverage from 99 to a total 140 metropolitan markets. Approximately 71% of U.S. households headed by someone age 75 and older are situated in these 140 markets.