Health Care Cost

A national study of 120 payers has found that nearly two-thirds of payments are now based on value, and value-based care is helping stakeholders to achieve the triple aim of lower costs, improved health, and better patient experiences.

A group of experts identified 6 high-need populations and dimensions of successful care models to improve outcomes and reduce spending for these populations.

Healthcare organizations have sent a letter to HHS, urging it to count physician participation in Medicare Advantage (MA) plans toward participation criteria for the Advanced Alternative Payment Model track of the Quality Payment Program.

A study of baseline characteristics and spending of hospitals participating in Medicare's voluntary and mandatory orthopedic bundled programs found that there were few differences, indicating that mandatory programs could engage more hospitals that otherwise would not have participated in voluntary programs.

Although accountable care organizations cover more than 32 million people in the United States, the financial savings have been limited and the outcomes are unknown. Place-based approaches aimed at integrating care, improving population health, and controlling costs may be beneficial to adopt as the United States moves away from mandatory participation in payment reform.

An analysis of the 4 years of the Comprehensive Primary Care Initiative found slowed growth in emergency department visits, but no significant changes in Medicare spending or claims-based quality of care.

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.

Integrated care teams will create more value for the patient, but there are multiple challenges in the creation of these teams, said Mark Soberman, MD, MBA, FACS, former president of the Association of Community Cancer Centers.

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.

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.

"If clinicians are burning out, it is unlikely that participation in new payment models will be sustainable," explained Mark Friedberg, MD, MPP, senior natural scientist and director of the Boston office at RAND Corporation.

The third annual population health survey from Numerof & Associates found that healthcare organizations have not made as much progress to transition to risk-based agreements as they predicted they would 2 years ago.

Getting to value in healthcare has proven to be difficult, but succesful programs have certain characteristics, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

Shantanu Agrawal, MD, MPhil, CEO and president of National Quality Forum, recognizes the importance of diminishing health disparities.

In a commentary for New England Journal of Medicine, Karen E. Joynt Maddox, MD, MPH, of Washington University School of Medicine, outlines key principles for designing alternative payment models (APMs) to avoid harming vulnerable populations and penalizing the providers who care for them.

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 changes to the Next Generation ACO Model caused 7 accountable care organizations to leave the model; a report highlights how quickly hospital acqusition of physician practices is occurring; CMS finalizes coverage for Next-Generation Sequencing tests.

Results from the ODYSSEY Outcomes trial for the PCSK9 inhibitor alirocumab were the top news at the meeting.

Overview of alternative payment models and how leading national organizations are involved with linking quality improvement initiatives and payment reform.

The report finds a connection between payment reform and hospital use patterns, but that connection may add to the debate that cardiologists have raised over the effect on patients.

Coverage of the 67th Scientific Session of the American College of Cardiology.

In healthcare, the “volume-to-value” movement seeks to align the interests of healthcare providers with the societal triple aim of better care, better health, and lower costs. The devil, as always, is in the details.

Replacing the Merit-based Incentive Payment System (MIPS) with a voluntary program should encourage providers to move quicker into more risk-based payment models, according to Travis Broome, vice president for policy at Aledade.

Curbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.

Adapting payment models to reward outcomes is key to making lifestyle change fit into a managed care framework, several articles find.

Donald M. Berwick, MD, MPP, FRCP, and Patricia Salber, MD, MBA, discuss the idea of a single-payer system and misconceptions about the concept, and what individual states are doing.

Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss payment reform in the healthcare industry, including quality measurements and accountable care organizations.

New Jersey is 1 of 3 states that will test a new set of metrics to assess how well new payment models have penetrated markets, explained Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, which will lead the process in New Jersey.