Interviews

One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

Despite increasing mergers, hospitals can stay competitive in consolidated markets by utilizing tiered or narrow networks, said Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

Physicians develop biases against obese patients due to inadequate education on obesity during medical school, explained Janine V. Kyrillos, MD, FACP, of Thomas Jefferson University Hospitals and the Sidney Kimmel Medical College. She hypothesized that physicians become frustrated with the lack of solutions they have to offer and then shift the blame onto the patients.

Many institutions and researchers responded to the PAN Challenge call for papers last year, and even more are expected this year, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation. He emphasized that this year’s Challenge is especially important because it can help reduce the financial hardships that many cancer patients often face.

Omada Health’s Prevent program has enrolled nearly 55,000 patients since its start in 2012, and has been demonstrating successful, real-world applicable results for patients with pre-diabetes, said Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

As mobile health advances help engage patients as active partners in their healthcare, these technologies can potentially harness that engagement and connect them with interventions, said Leah Sparks, co-founder and CEO of Wildflower Health.

CMS has taken steps to make clinical practice improvement regulations easier for independent practitioners to understand and achieve, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

A patient may be aware of the complications that could arise from a lack of adherence with a chronic disease like diabetes, but education is not enough to change a patient’s lifestyle, explained Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth.

ACOs have great potential in helping achieve a more value-based delivery system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation. She also discussed the challenges that safety net ACOs face in delivering care with fewer resources.

Clinicians may at first be confused by new value-based care regulations, but there are resources to help them understand, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Patricia Salber, MD, MBA, of The Doctor Weighs In, doesn’t believe the healthcare industry will become anything like that of the retail or travel industry, as healthcare is very complicated and consumers may not always be making their own decisions, especially in cases where patients are seeking hospital treatment.

Payment reform in the United States is moving quickly, but there are still a lot of unknowns among providers. Meetings like the ACO & Emerging Healthcare Delivery Coalition help accountable care organizations (ACOs) and providers share best practices and figure out how to succeed, said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and keynote speaker at the ACO Coalition's fall meeting in Philadelphia, Pennsylvania, October 20-21. Learn more about the meeting and register.

Data analytics used to be done in a retrospective manner, and physicians would be looking at the data long after the patient left his or her visit. Now, Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics, explained that her and her team have brought data diagnostics back into the physician’s workflow for easier and faster use.

Mark Lovgren, director of Telehealth Services at Oregon Health and Science University, described how the telementoring program Project ECHO fits into the university’s toolbox of telemedicine programs despite an initial learning curve.

The PAN Challenge is seeking long-term sustainable strategies to expand affordable access to care, which will benefit seriously ill patients the most, according to Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation.

Despite concerns, the use of telehealth visits does not have a significant impact on the overall budget, explained Kristen McGovern, JD, partner at Sirona Strategies. In fact, a recent study found that using telehealth services decreased costs over the long term.

Understanding the population a company serves is important in giving the individual what they want, said Jay Sheehy, senior vice president of product innovation at EmblemHealth. Fact-based information and consumer-oriented solutions are 2 strategies that Sheehy said healthcare companies could deploy to learn more about the consumer and in turn, better engage their customers.

Hospital consolidation has resulted in fewer choices for physicians and higher costs for patients, insurers, and taxpayers, according to Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

In terms of managing hospital readmissions, Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System, said that a hospital must not only consider the care given to a patient but the social situation he or she may be coming from.

While body mass index is a good indicator for obesity, there are various other factors and clinical symptoms that need to be taken into account when diagnosing and treating a patient for obesity, explained Ted Kyle, RPh, MBA, principal at ConscienHealth.

Medicaid programs must find a balance between confidentiality and patient safety when prescribing opioid painkillers, says Matt Salo, executive director of the National Association of Medicaid Directors.

The funds that the Patient Access Network (PAN) Foundation provides to patients are often used to help with the cost of medications, and there has been a large increase in the number of patients looking for assistance for the cost of cancer treatments, explained Daniel J. Klein, president and CEO of the PAN Foundation.

While working for Horizon Healthcare Innovations, Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, gained insights on how best to transition to a pay-for-outcomes system and was able to actively work with healthcare stakeholders who were engaging in these models.

CareSource is helping to bridge the gap in a patient’s care by working within that space to pull together the various stakeholders and put the patient’s care needs at the forefront of the conversation, said Karin VanZant, executive director of Life Services at CareSource.

Digital health programs like telehealth have already made progress in fields like mental health by expanding access and lowering costs, but there are opportunities to achieve much more in the future, according to Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

Personalized medicine looks at a patient’s genome, but precision medicine takes more of their social and individual determinants into account, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

CMS reached its goals for value-based payments in part because of providers’ enthusiasm for new programs, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

CMS' star ratings for hospitals have been controversial because they penalize hospitals that disproportionately care for the poor and the sick, and efforts by CMS to adjust the methodology haven't really addressed the concerns, explained Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.

The integration of data analytics into everyday use has allowed physicians to better engage in the patients care by intervening and taking action early, which ultimately improves quality of life and outcomes, said Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.