Study Looks at ACO Formation Drivers

An article in Physicians Briefing points to a study published in the October issue of Health Affairs that suggests that underlying provider integration in a given geographic region may be the key that drives the formation of Medicare accountable care organizations (ACOs),

The researchers found that a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups were key regional factors associated with ACO formation.

The study is available for purchase at

CMS Health Care Innovation Awards Round Two

The Centers for Medicare & Medicaid Services (CMS) has released a Funding Opportunity Announcement for round two of the Health Care Innovation Awards. Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

In this round, CMS specifically seeks new payment models to support the service delivery models funded by this initiative. All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model that they propose.

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San Francisco Area Health Centers Seek to form ACO

A prominent group of health centers in the North Bay (San Francisco) has applied to form what is known under the new federal health law as an “accountable care organization” serving thousands of Medicare patients that, if approved, could be one of the first of its kind in the nation.

Under the ACO program by Medicare, health care providers and payers are encouraged to better coordinate care, hoping to achieve the so-called “triple aim” of improving quality of care, improving patient experience and reducing costs, officials said.

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GoHealth Confirms Web Broker Entity, Agent Agreements With U.S Government

CHICAGO, IL–(Marketwired – Aug 19, 2013) –, the nation’s most complete health insurance marketplace and leading online exchange for individuals and families to compare health insurance quotes, today confirmed that it had reached an agreement to aid the U.S. government with health insurance enrollment for millions of tax-subsidy eligible Americans. This agreement with The Centers for Medicare & Medicaid Services (CMS) will enable the company to enroll millions of eligible consumers in qualified health plans through by leveraging the Federal data hub behind the Federally-Facilitated Marketplace (FFM).

A separate Individual Marketplace Agreement reached with CMS relates to the FFE integration and the enrollment of consumers on in qualified health plans (QHPs) through the Federally-Facilitated Health Insurance Exchange (FFE). These agreements clear the way for GoHealth’s integrated shopping experience for consumers looking to enroll in health insurance plans.

Many Americans will be purchasing health insurance for the first time under the new health reform, and GoHealth’s extensive background and expertise in both online and offline health insurance sales gives them a unique advantage.

“Our combination of online and offline sales and support from thousands of licensed insurance advisors across the country allows us to help even those who aren’t as Internet savvy enroll in the best health insurance plan for them in a manner that’s both quick and easy,” said Clint Jones, CEO of GoHealthInsurance.

During the negotiations leading up to the agreement, GoHealth and CMS have been working to integrate both entities’ technology systems to ensure that both are ready for the influx of new health insurance shoppers come October 1st.

GoHealth will also offer off-exchange and ancillary products that are not available on the federal site allowing many consumers more choice through this marketplace than the federal exchange alone.

“We are pleased that the agreement with CMS allows us to integrate every single qualified health plan offered on the federal marketplace into our platform along with off-exchange plans offered by major health insurers,” said Brandon Cruz, President of GoHealthInsurance. “This expanded combination of products, backed by the needs analysis processes built into our technology and support centers, means greater choices and a better shopping experience for the consumer.”

This integration additionally gives consumers who do qualify for subsidies the ability to apply those subsidies to their premiums immediately on as opposed to getting a refund at a later date.

GoHealth has plans to offer health insurance plans in all 50 states including the 14 states and DC that do not currently leverage the FFM.

“With over 10 years of experience building technology for national and state-based entities, I’m confident that we can help these remaining states solve the specific state-based issues they are facing as they work to meet the October 1 deadline for open enrollment,” commented Jones. “It’s just another step in our mission to help consumers get answers, get help, and get coverage.”

GoHealth has been recognized as one of the 100 Best Workplaces in Chicago and received Chicago’s 101 Best and Brightest Companies award from the National Association of Business Resources, along with appearing on the Inc. 500’s Fastest Growing Companies in America list.

For additional information on this web broker agreement, please


eHealth, Inc. Signs Agent Agreement With CMS

MOUNTAIN VIEW, CA — (Marketwire) — 08/16/13 — eHealth, Inc. (NASDAQ: EHTH), the nation’s leading private online health insurance exchange for individual and family health insurance, today announced that it has entered into an agreement with the Centers for Medicare and Medicaid Services (CMS) that relates to its ability to enroll individuals into qualified health plans (QHPs) through the Federally-Facilitated Health Insurance Exchange (“FFE”).

In July, eHealth signed an agreement with CMS that would allow it to access certain information from the federal data hub. This access is necessary for eHealth to act as a web-broker entity (WBE) and use its website to enroll individuals eligible for Patient Protection and Affordable Care Act subsidies in QHPs through the FFE.

The new agreement signed by eHealth must be signed by any agent or broker that wishes to enroll individuals in QHPs through the FFE. Under the agreement, eHealth pledges to meet registration, training and licensing requirements established by the FFE. The agreement also requires eHealth to comply with privacy and security standards and applicable laws and regulations. eHealth will also need to integrate with the FFE and implement a QHP shopping experience on its internet platform before it can enroll people in QHPs as a WBE.