CMS' Innovation Leader Touts Value of Physician Feedback
October 30th 2019The Oncology Care Model is a leading innovation in the move from fee-for-service to value-based reimbursement in large part because CMS has made adjustments based on physician feedback, according to an agency official who addressed the Community Oncology Alliance Payer Exchange Summit.
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Data Collaborations Are Driving Improvements to the Use of Real-World Evidence
October 30th 2019As the number of expedited FDA approvals for cancer drugs that are based on surrogate end points increases, so does the need for new ways to uncover efficacy and safety data to justify the costs associated with these treatments. With the growth of data innovations and collaborations, the answer might be found in real-world evidence.
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Providers Move Forward With 2-Sided Risk and Take on Pharma
October 29th 2019Heading into 2019, the idea that oncology practices would fully embrace financial responsibility for clinical decisions still seemed far-fetched for many. And yet, when it was time to make the call, moving to 2-sided risk proved a “simple” decision, said Travis Brewer of Texas Oncology, who took part in a panel offering an update on the Oncology Care Model (OCM) at the start of the Community Oncology Alliance (COA) Payer Exchange Summit, which opened Monday in Tyson’s Corner, Virginia.
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As costs for cancer care continue to rise, Pontchartrain Cancer Center does benefit and cost analyses for all patients before they start therapy and also takes into account any social needs they might have, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center.
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What Do Physicians Really Think of Quality Metrics, and What's Needed to Drive Better Performance?
October 12th 2019There’s a question as to whether these metrics actually translate into what’s actually driving quality care, explained Loren Meyer, MD, president of HCA Physician Services, during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum being held October 10-11 in Las Vegas, Nevada.
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Implementing Rapid and Effective ART Initiation to Successfully Manage HIV
October 11th 2019Mary Montgomery, MD, associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School, discussed emerging treatment strategies for managing HIV during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.
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Navigating Challenges With Determining Value, Reimbursement of Genetic Testing
October 11th 2019During a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum being held October 10-11 in Las Vegas, Nevada, Kathryn Phillips, PhD, founding director of the University of California, San Francisco Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), discussed the emergence and rise of genetic testing, the challenges of determining value and reimbursement, and what’s ahead for these tests.
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Keeping Up With Changes in Medicaid
October 11th 2019As of November 2018, Medicaid is the largest healthcare program in the United States, covering 1 in 5 Americans, and over two-thirds of beneficiaries are enrolled in private managed care plans. Alongside this trend are shifts in care delivery under Medicaid, as well as challenges and solutions being posed by value-based care models, all of which was discussed during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum being held October 10-11 in Las Vegas, Nevada.
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Leveraging an Integrated Population Health Model to Improve Costs, Quality, and Satisfaction
October 11th 2019During a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada, Cary Shames, DO, CHCQM, ABQAURP, vice president and chief medical officer, Sharp Health Plan, discussed using an integrated population health model to drive better quality and satisfaction of care while lowering costs.
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Are Value-Based Models Helping or Hindering Care Delivery for Primary Care Providers?
October 11th 2019Value-based models continue to enter the healthcare system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a way to “save” primary care, that's not the current reality, said Theresa Hush, chief executive officer of Roji Health Intelligence, LLC, during a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.
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Pursuing Perfection in Healthcare to Reduce Suicides to Zero Requires More Than Tweaking
October 6th 2019The idea that zero suicides are possible must begin with “the radical conviction that ideal healthcare is attainable,” said C. Edward Coffey, MD, affiliate professor of psychiatry and behavioral sciences at the Medical University of South Carolina.
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Old Challenges Meet New Ones When Treating Women With Psychiatric Illness Before or During Pregnancy
October 5th 2019Clinicians need to keep certain facts about mental illness and unintended pregnancy in mind when treating female patients of reproductive age, said an expert in mental illness, pregnancy, and women's health.
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Addressing Medication Adherence Among Patients With Mood, Psychotic Disorders
October 4th 2019Medication adherence is critical not only to clinical outcomes, such as preventing readmissions, but also to containing costs, with adverse outcomes as a result of nonadherence often resulting in higher costs for both the patient and the healthcare system. Ensuring adherence can be especially challenging among people with mood and psychotic disorders.
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Treating OCD Successfully Requires Evidence-Based Approaches, Says Expert in Complex Cases
October 4th 2019Jon Grant, MD, JD, MPH, a professor of psychiatry and behavioral neuroscience at the University of Chicago and expert in severe and complex cases of obsessive compulsive disorder, discusses evidence-based approaches to this little-understood disease.
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Identifying 7 Best Practices of Successful ACOs
September 28th 2019During the second plenary at the National Association of ACOs fall meeting, Meridith Seife, deputy regional inspector general, Office of Evaluation and Inspections in the HHS Office of the Inspector General, presented results from a government report identifying strategies of high-performing accountable care organizations that had improved care quality while cutting costs.
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The Challenge of Fitting Together All the Pieces to Deliver Holistic, Value-Based Care
September 27th 2019In the next 5 to 10 years, providers and health systems need to be thinking about how all the pieces of a new system that delivers holistic, value-based care fit together, said Will Shrank, MD, chief medical officer, Humana, during the opening plenary at the National Association of ACOs fall meeting.
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Susan Dentzer on Finding Room to Pay for Expensive, Life-Changing Therapies
September 15th 2019To make headroom for expensive, potentially curative therapies in the pipeline, the healthcare needs to remove ineffective care from the system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy.
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