Last Friday we talked about fee for service, the model where every needle, every test, every fifteen minute visit gets billed and paid for separately. It is the oldest payment model in American medicine, and for most of the twentieth century it was the only one that mattered. By...
On April 10, the Centers for Medicare and Medicaid Services released its proposed rule for the Fiscal Year 2027 Inpatient Prospective Payment System. Buried in a 2,000 page document is a proposal that will reshape how new medical devices reach Medicare patients. CMS is proposing to repeal what’s called...
I want to start with a number. Just one. Two percent. That is the share of UnitedHealth Group’s total claims volume captured in the federal data that journalists, researchers, and members of Congress have been using to hold the company accountable. Two percent. The other 98%, employer-sponsored plans, Medicaid...
Over the next several weeks, we’re going to walk through the payment models that drive American healthcare: fee for service, prospective payment, capitated payment, value-based care, bundled payments, and global budgeting. Each one shapes a different piece of the system you live inside every day. Understanding them is understanding...