Alternative Payment Models

A new rule from CMS for 2019 would allow for more flexibility in benefit design for Medicare Advantage enrollees with specified chronic conditions.

As benchmarking is now becoming a part of payment models, practices realize they need comparative data to understand how well they perform relative to their competitors and whether there is room for improvement.

Since the launch of the Blue Distinction Total Care program, it has outperformed 96% of industry quality measures in key healthcare quality and patient health metrics, The Blue Cross Blue Shield Association (BCBSA) announced.

Value-based payment reform provides an opportunity for increased resources and improved short- and long-term health outcomes for children, wrote experts in a JAMA Pediatrics Viewpoint article.

So far, the move to accountable care has been promising, but more needs to be done to encourage providers into risk, said panelists at The American Journal of Managed Care®’s Accountable Care Delivery Congress.

A group of healthcare organizations have come together to advocate for policies that support independent practices moving to risk-based care models.

Employers may be intimidated by the idea of purchasing healthcare, but they are getting more involved in it and they are in a position to transform the market and promote value-based care, said Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, during her keynote at The American Journal of Managed Care®’s Accountable Care Delivery Congress.

Since its inception, the Center for Medicare and Medicaid Innovation (CMMI) has implemented 37 models testing healthcare delivery and payment reform. A new Goverment Accountability Office assessment found that CMMI has partially met goals for performance targets.

Since March 2014, nearly 14,000 genetic tests have entered the market, with about 10 new tests appearing daily. A study published in Health Affairs sought to clarify unanswered questions surrounding genetic testing markets, test usage, and health policy implications.

Practice reorganization can worsen clinician burnout, explained Mark Friedberg, MD, MPP, senior natural scientist and director of the Boston office at RAND Corporation, who also discussed his solutions for addressing burnout in the practice.

Farzad Mostashari, MD, of Aledade, and Richard Gilfillan, MD, of Trinity Health, highlight the successes of accountable care organizations (ACOs) and how they've impacted care across the healthcare system, and offered suggestions for improving the Medicare Shared Savings Program.

Practices increasingly need to use technology to deliver care in an increasingly value-based world, said Charles Saunders, MD, CEO of Integra Connect.

The National Association of Accountable Care Organizations (NAACOS) said Wednesday that a survey it conducted showed 71% of respondents indicated they are likely to leave the Medicare Shared Savings Program (MSSP) due to concerns over having to assume risk.

The past few years have seen a number of measures implemented that put the brakes on the rapid consolidation of practices and the upward spiral in costs of cancer care borne by CMS.

CMS has released the first round of reconciliation data from the Oncology Care Model (OCM) bundled payment program. Interestingly, some of the practices that did well were surprised to learn they they’d achieved savings, and some participants were pleased to find out that their level of performance met expectations.

A shift in care delivery and the availability of data are helping to make value-based care a reality in the United States, but the change has been taking too long, said panelists at the 15th Annual World Health Care Congress.

Results on bundled payment models are mostly promising, but not consistent. However, while most program results trend in the positive direction, many of studies on bundled payments may not capture the full picture.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included an announcement from CMS of creating direct provider contracting, plus a broad set of proposed rules for health information technology; new recommendations to improve postpartum care; a look at future competition among specialty drugs.

Problems in healthcare seem overwhelming, with at least 17 different factors cited as driving unsustainable spending, according to a presentation at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts. Two executives from Precision for Value LLC spoke about “Charting the Shifting Value-Based Healthcare Landscape: Emerging Developments for 2018 and Beyond” and offered their view on what healthcare companies can do to succeed.

In an effort to make good on its plans to give patients more control over their health information as well as reduce the number of quality measures healthcare providers have to report, CMS announced changes in both of those areas Tuesday.

A new report suggests ways policy makers can support and advance value-based payment models so payment innovations can catch up to healthcare delivery innovations.

Recent changes in the healthcare industry can both contribute to and exacerbate clinician burnout, but can also improve the situation, said Kathleen Blake, MD, MPH, vice president for Performance Improvement at the American Medical Association.

Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders and chair-elect of the American Society of Clinical Oncology’s (ASCO) Clinical Practice Committee discusses the first results of the Oncology Care Model (OCM) and ASCO’s top legislative priorities.

If most practices excel at the same clinical practice measures, then small differences in performances could lead to significant financial differences, a speaker warned.

Humana has launched a new maternity bundled payment model with 5 practices in Indiana, Kansas, Ohio, and Texas to improve quality, outcomes, and cost across the entire perinatal episode of care for women with low- to moderate-risk pregnancies.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Reimbursement models, novel gene therapy–based treatments, and price transparency: these were some of the topics covered by presenters and panelists at the annual meeting of the Community Oncology Alliance.

This week, the top managed care stories included a new bill in Congress to tackle the opioid epidemic; an analysis that warns against including drug costs in bundled payment models; the FDA commissioner shares ideas to improve innovation and access to next-generation sequencing.