Health Care Cost

Value-based care in oncology will be a great thing for patients because it will bring the caregivers together, said Roy Beveridge, MD, chief medical officer of Humana and the keynote speaker at Patient-Centered Oncology Care.

The goal of medicine is function and health. Clinicians who marry technical skills with humanities can see their patients and themselves in the larger context of family, society, history, politics, and economics.

As the healthcare industry moves toward value-based care and accountable care organizations and other new financial models gain greater importance, Aledade is looking to guide physicians to success.

With value-based reimbursement now far from its infancy, the chief medical officer for Humana will forecast what’s ahead in payment reform-and how oncology connects with what is happening in primary care, hospitals, and the pharmaceutical industry. Roy A. Beveridge, MD, will open Patient-Centered Oncology Care, which will meet November 17-18, 2016, in Baltimore, Maryland.

Read on for a breakdown of what to expect from the near-final MACRA rule announced by CMS on October 14, 2016.

Can care delivery and payment reform in healthcare help tide us over the existing gaps in cancer care?

The Affordable Care Act called for making it easier for practices to pursue models like collaborative care by allowing physicians to bill for it.

A new study published in JAMA Internal Medicine found that more than 25% of older adults have not engaged in planning for end-of-life care or advance directives.

A new report looks at how Medicaid in states that expanded the program are pursuing alternative payment models in order to better respond to the complex health and social needs of beneficiaries.

What are some of the challenges that clinical practices will face as they implement the Medicare Oncology Care Model (OCM)? What are some of the strategies that have worked for practices using similar payment models? These were some of the questions discussed at the Payer Exchange Summit V.

At the Payer Exchange Summit V, sponsored by the Community Oncology Alliance, held October 24-25, 2016, in Tyson’s Corner, Virginia, Bruce Gould, MD, presented an overview of how cancer care has improved over the years, what the challenges are, and how practices can adapt to payment reform.

The number of accountable care organizations (ACOs) has grown rapidly over the last 4 years, with more than 800 ACOs now covering an estimated 28 million Americans. A study found that commercial ACOs were significantly larger and more integrated with hospitals and had lower benchmark expenditures and high quality scores compared with noncommercial ACOs.

Despite progress, tying healthcare payments to value has proved easier in theory than in practice, according to speakers at this fall’s meeting of the ACO & Emerging Healthcare Delivery Coalition. Experts convened October 20-21, 2016, by The American Journal of Managed Care looked ahead at the challenges the next president will face with the future of the Affordable Care Act.

Panelists in the Healthcare 2020 series discuss the challenges with the exchanges that will be waiting for the next president, the future of Medicaid expansion, and how the complexity of so many models is burdening ACOs.

Accountable care organizations (ACOs) have been laying the groundwork for the requirements for the Medicare Access and CHIP Reauthorization Act (MACRA), which will give physicians participating in ACOs an advantage during the implementation of the new Medicare payment system, said Katherine Schneider, MD, president of the Delaware Valley ACO.

To create flexibility during the transition to the payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), CMS has created something called “pick your pace,” explained Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

In the keynote speech at the ACO & Emerging Healthcare Delivery Coalition, Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy, started out by providing a broad picture of Medicare reform before narrowing it down to what is happening on the ground.

The top stories in managed care included Vice President Joe Biden's released his report on the Cancer Moonshot initiative, complaints were filed against 7 insurers for discriminating against people with HIV, and Pfizer announced it plans to launch its Remicade biosimilar in November.

Dr. Song is a resident at Massachusetts General Hospital and a clinical fellow at Harvard Medical School. The American Journal of Managed Care presents the award to an early-career researcher whose achievements show the potential for exceptional long-term contributions in the field of managed care.

In creating the final rule for the Medicare Access and CHIP Reauthorization Act, CMS did an excellent job listening to, and responding to, a vast array of comments from healthcare stakeholders.

This week, the top stories in managed care included HHS releasing the final rule for the Medicare Access and CHIP Reauthorization Act, a commentary on the downside of drug coupons, and the World Health Organization called on countries to enact a soda tax.

HHS has finalized the landmark Medicare Access and CHIP Reauthorization Act (MACRA), which reforms payment for Medicare providers and replaced the sustainable growth rate formula.

The partnership is expected to improve the quality of care and the overall care experience for Aetna members who seek care at Regional Cancer Care Associates (RCCA) clinics in New Jersey and Maryland.

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.

Although hospitals in Medicare’s Value-Based Purchasing program already receive patient experience points based on achievement, improvement, and consistency, placing more emphasis on improvement points could benefit hospitals serving minority patients

With 6 years under his belt, Patrick Conway, MD, is the longest serving chief medical officer in CMS history. During those 6 years, he has seen alignment with private payers increasing, Conway said during a plenary session at the fall meeting of the National Association of Accountable Care Organizations.

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.

During the fall meeting of the National Association of Accountable Care Organizations (NAACOS) in Washington, DC, speakers from the government and from various ACOs across the country shared their insights into the success and opportunities of these delivery models. Here are 5 takeaways from the NAACOS fall conference.

According to a new proposal by the Center for American Progress, Medicare and private health insurance companies should have the power to negotiate drug prices with manufacturers, empowered by comparative effectiveness research data.