Health Care Cost

There is a need for a new stop loss formula that ensures a level playing field and motivates accountable care organizations.

This week, the top managed care stories include Humana announcing executive bonuses are now partially tied to value, Veterans Affairs has expanded access of hepatitis C drugs to all veterans in the system, and CDC releases guidelines on prescribing opioids.

As the industry continues its move to value-based care, health plans need to build trusted relationship for the move to be successful, according to Charles Fazio, MD, MS, medical director of HealthPartners, Inc.

The 42nd annual meeting of the Association of Community Cancer Centers ensured that none of the oncology care providers in the audience left without realizing that healthcare has slowly been migrating to include value in care delivery and reimbursement decisions.

At the end of February, Ted Okon, MBA, executive director of the Community Oncology Alliance (COA), answered questions on Twitter about the latest trends in cancer care and discussed COA’s concerns with the president’s moonshot initiative and the 340B drug pricing program.

A new report published by the American Society of Clinical Oncology has drawn a mixed picture of oncology care in the United States-reduced mortality, increased survivors, and progress in treatment coupled with unsustainable costs and an unstable clinical setting.

Although health plan accountable care models have evolved provider readiness, data, analytics, and the use of performance measurement are important components of plan-provider partnerships.

The newly proposed Medicare Part B payment demonstration met immediate criticism from some in the healthcare industry. Chip Kahn, president and CEO of the Federation of American Hospitals, is also very hesitant about the demonstration and worries that it might be premature.

Public and private payers all heading in the same direction in regards to payment reform is sending a consistent message to providers and creating alignment in healthcare, said Stephen Ondra, MD, senior vice president and enterprise chief medical officer at Health Care Service Corporation.

The average cost per episode dropped $6708 from the first year of the pilot to the third year.

The implementation of a reference-based payments program by the California Public Employee's Retirement System reduced payments for colonoscopies by $7 million over 2 years.

Oncologists now face a cost discussion that was not part of their medical training. It's a balancing act between the big picture of understanding the burdens on the system and "the patient in front of you."

Keynote speaker Dr Julie Vose said the oncologist faces many administrative burdens in the transition to value-based care. Solving them is essential to spending more time with the patient.

The value of the ACO & Emerging Healthcare Delivery Coalition live meetings is the information exchange that happens among organizations that are all looking at the same problem but from different angles, said Tabatha Dragonberry.

The top stories in managed care this week include findings on cancer survival disparities, CVS Health claimed drug spending growth slowed in 2015, and Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan is interfering with existing patient-centered medical homes.

Pay-for-performance (P4P) programs have the potential to improve overall quality of care and the prevalence of these programs has increased in the last 15 years. Here are 5 things to know about P4P and how it can impact healthcare in the move to value-based care.

Payment reform in the US is progressing considerably, but more transparency is necessary in order to change payment for the better in the United States, said Elizabeth Mitchell, president and CEO of the Network for Regional Healthcare Improvement.

Ted Okon, MBA, of the Community Oncology Alliance, will participate in a tweetchat with The American Journal of Managed Care on February 29, 1-2 pm ET, to discuss the 340B program, payment reform, the Oncology Medical Home, and more.

The full slides from the 2015 Patient-Centered Diabetes Care keynote speech, where Robert A. Gabbay, MD, PhD, discussed new care models being implemented to improve patient health in the long term.

Risk adjustment for social determinants of health could reduce penalties to children’s hospitals for patient factors that are beyond their control, according to the results of a new study published in JAMA Pediatrics.

Population health, healthcare value, innovations in healthcare, cost of care-these were just some of the topics discussed at the meeting.

The shared savings payments were for specialists in hip and knee replacements, knee arthroscopy, and pregnancy. These areas have been among CMS' top targets for savings, while New Jersey has been focused on reducing its high rate of C-sections.

A collaboration led by CMS and America’s Health Insurance Plans released 7 core sets of quality measures created to reduce complexity, decrease cost burden, and ensure high-quality care.

A summary of updated breast cancer screening guidelines, MEDPAC recommendations for 340B, and disparity in survival of young patients with Hodgkin lymphoma.

A. Mark Fendrick, MD, co-editor-in-chief of The American Journal of Managed Care and director of the University of Michigan Center for Value-Based Insurance Design, testified before a Michigan senate subcommittee on the benefit of clinical nuance.

What we're reading, February 9, 2016: Novartis signs 2 performance-based deals for its new heart drug; 8 states significantly reduced uninsured rates; and the Obama administration will ask for $1.8 billion to prepare to fight the Zika virus.

The Network for Regional Healthcare Improvement (NRHI) has been leading a project to measure and report on total cost of care across different regions, and the end result could inform payment change, care delivery design, and health policy, explained Elizabeth Mitchell, president and CEO of NRHI.

Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, describes the proposed changes to the Medicare Shared Savings Program and how they will assist accountable care organizations transitioning to tracks with more risks.

The latest piece in HHS’ roadmap to move the healthcare industry to value-based payments is the Accountable Health Communities model. Here are 5 things to know about how this model addresses social determinants of health.

The healthcare industry is undergoing payment reform, which includes important initiatives like addressing social determinants of health, but may not be keeping the patient perspective central as these changes are made, Lewis Sandy, MD, senior vice president of Clinical Advancement at UnitedHealth Group, said at the AcademyHealth National Health Policy Conference.