Health Care Cost

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.

An effort by the University of Utah health system created an "opportunity index" to identify areas of cost variability that would show physicians where they could find savings and improve quality.

In this podcast Margaret E. O'Kane discusses how she got into quality measurement, the beginning of the National Committee for Quality Assurance, and the next frontier in quality measurement.

This week in managed care, the top stories included new reports on a 10-year experiment in payment reform, more results from the early years of the Affordable Care Act, and findings on employee wellness programs.

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.

A majority of hospitals that may be required to participate in the new Medicare cardiac bundled payment models would not experience losses or gains over $500,000 per year, according to a recent analysis by Avalere Health.

Highlights from the recent gathering of the American Association of Diabetes Educators, which met August 12-15, 2016, in San Diego, California.

Precision oncology, or the clinically and financially efficient use of genomically matched treatments and clinical trials, is evolving as a potentially important starting point for cancer care within successful alternative payment models.

The authors apply HHS’s payment taxonomy framework to acute unscheduled care and describe how payment reform supports delivery innovation.

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.

This week, the top stories in managed care included the release of Medicare's Star ratings for hospital quality, a new proposal from CMS to require bundled payments for cardiac care, and an FDA panel recommended approving a continuous glucose monitoring system for dosing insulin.

To help clinics meet the objectives and reporting requirements of the Oncology Care Model (OCM), Flatiron Health has developed OncoEMR, a cloud-based electronic health record (EHR) coupled with an analytics tool.