Interviews

Payment reform's impact on socioeconomic disparities may not matter if the growth in healthcare expenditures in the United States means the government or payers can’t afford to pay for the medicines, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.

While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that care coordinators have played an important role in his ACO to reach out to the patient and motivate them to become more engaged in their care. What makes a difference is showing the patient how much you care, he added.

Performance measurement is at the heart of improving healthcare, and part of this transition to value-based payment means creating measures that track the improvements of quality care, said Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum.

Ted Kyle, RPh, MBA, principal at ConscienHealth, explained that in order to prevent diabetes, a patient’s health-related risks needs to be addressed, and part of these risks stem from obesity. He added that a program like Medicare’s diabetes prevention program is exactly the tool the curb this progression.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), explains some of the biggest transitions she faced in moving from the public sector of working with HHS to the private sector of now working with AHIP.

Rethinking the ways in which hospitals get reimbursed and removing barriers to patient centered care are just 2 ways in which hospitals can consider moving from volume to value, said Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System.

Jay Sheehy, senior vice president of product innovation at EmblemHealth, explained that improving customer experience is important in engaging the individuals, which can only be done if the health plan thinks more like a consumer and less like a healthcare company. Research and analysis as well as figuring out what is most important to the consumer is critical in engaging patients with their care.

While the implementation of the ACA helped to manage healthcare costs in the beginning, Patricia Salber, MD, MBA, of The Doctor Weighs In, said that there are just certain factors that will always make dealing with growing costs very difficult.

Not only are patients with prediabetes benefiting from Omada Health’s Prevent program, Omada benefits as well by learning from the enrolled patients about how to better serve the Medicaid population, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

Rocco Perla, president of Health Leads, explained that not only do stakeholders in the health system need to come together, but that the conversation also must be patient-centered to truly make headway in care reform.

In a series of video interviews, Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement, discussed the lessons learned from the Aligning Forces for Quality initiative.

Digital technology has great potential to improve the communication between providers and members, said Albert Tzeel, MD, MHSA, FAAPL, regional medical director of senior products at Humana. However, there are also drawbacks that come alongside digital technology that Dr Tzeel said is worth considering.

Getting people to change their mentality when it comes to their health is a very difficult prospect, but one that researchers attempted to tackle as part of the Aligning Forces for Quality (AF4Q), explained Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement. Berwick served as the special guest editor for the supplement publishing results of the AF4Q initiative.

Karin VanZant, executive director of Life Services at CareSource, explained that 1 issue in trying to improve the US healthcare system overall is that stakeholders are not taking a macro perspective approach. She said that what individuals and industry stakeholders should be focusing on is overall American well being, which includes aspects like housing and food access.

Medication adherence is a complex issue, and Lonny Reisman, MD, CEO of HealthReveal, emphasized the importance of better understanding what methods or strategies will help motivate patients to do what is in their best interest.

While Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, believes that the ACO model is here to stay, he said that the way these organizations operate are likely to change.

Pathways have a unique ability to bring a personalized experience to the patient if the provider and care team can access the evidence they need to do so, said Alan Balch, PhD, CEO of the Patient Advocate Foundation. Therefore, the subgroups of larger patient populations must be considered closely when constructing those pathways.

Healthcare is moving toward integrating data systems and eliminating silos but economics and logistics remain barriers to electronic health records, according to Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.

The key in making coverage decisions about the integration of immuno-oncology agents into payment plans is being able to identify the patients who are most likely to benefit while also considering the long-term need for the acceptance of innovation in cancer care when faced with economic constraints, said Michael Kolodziej, MD, national medical director for oncology strategy at Aetna.

A hospital’s service does not end when the patient is discharged, as Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System, believes that it’s important to consider the hospital as a part of the greater community it serves in. Various hospital programs are helping patients transition from the hospital to their home by means of offering patients different housing options following their hospital stay.

Stephen Nuckolls, CEO of Coastal Carolina Quality Care, explained during his presentation at the National Association of Accountable Care Organizations Spring 2016 Conference that the more physicians read and learn about value-based care, the more they are accepting the change. He added that as the idea has become more accepted, ACOs are beginning to evolve as well.

Encouraging the use of generics is only one of the ways to manage the rising costs of medications, according to Karen Ignagni, president and CEO of EmblemHealth. Data and system transparency will also help both the patients and the payers better understand this growing trend.

The work of consumer outreach and enrollment is never done, as Jennifer Sullivan, director of the Best Practices Institute at Enroll America, said that it’s important to partner with community leaders to continue engaging consumers well into the future.

The future of Accountable Care Organizations is very much undefined, as an ACO right now isn’t working to its full potential. However, Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American, is positive that the healthcare system will get there in the coming years.

While there is no limit on the number of patients a physician can prescribe buprenorphine when sought for pain, physicians face governmental limitations on prescribing this medication to patients who need it as treatment for opioid addiction, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine. These restrictions have in turn created several patient access roadblocks to the needed medication.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, believes that while the tone of this year’s presidential election race has been interesting, the discussion among the candidates regarding issues of healthcare and coverage have generally been the same as elections in years past.

Many stakeholders in healthcare have concerns about the same issues just from different vantage points, they just need to be brought together in order to enact any change, explained Linda Schwimmer, JD, president and CEO at the New Jersey Health Care Quality Institute.

Patient adherence is about combining the appropriate tests, lifestyle changes and medications to produce the most optimal health outcomes, said Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth. However, he added that deciding when to pay physicians and patients for adherence and where payment may not be successful is a difficult model to tackle.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, explained that the 2 gaps that exist in quality measurement currently include data infrastructure and patient engagement.

Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics, explains where the future of data analytics is going in healthcare as the industry moves to value-based care.