Health Care Cost

The basis for determining Medicare payment rates for clinical diagnostic laboratory tests is changing. These changes will be important for all payers and providers to follow for future reimbursement and contract negotiations.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

The pay-for-performance model has come a long way in terms of how physicians are taking care of larger patients populations, according to Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

As personalized medicine rapidly becomes an effective tool for combating cancer, payers are exploring new, value-based payment paradigms. These trends will soon intersect, and depending on how they are structured, the new payment models could accelerate or stifle personalized medicine's progress.

A study attempting to characterize the true preventability of venous thromboembolism determined that financial penalties based on the total number of patients who suffer blood clots in the lung or leg may be unfairly imposed.

CMS' shift to value-based payments has also shifted diabetes care models from cost-centered systems to cost-savings centers, according to Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

On July 27 at 10 am EDT, The American Journal of Managed Care will host a tweetchat with the University of Michigan Center for Value Based Insurance Design to discuss moving from volume to value in healthcare and changing the cost discussion from "how much" to "how well."

As a part of the changing value-based payment model landscape, pay-for-performance programs for medication adherence measures are new for physicians and providers need help understanding the program, explained Mitzi Wasik, PharmD, BCPS.

A new blog post at RAND argues that Medicare's plans to reimburse providers for advance care planning has been a long time coming.

Accountable care organizations can play a key role in building a Culture of Health in which every person in America can have the healthiest life possible.

The challenges in transitioning to value-based payments are rooted in cultural and environmental issues at those institutions that have never truly paid attention to value-based care, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

As CMS continues to transform the Medicare program to a quality- and outcomes-based system, the agency is proposing to support patient- and family-centered care for Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

Despite efforts by states to introduce legislation to make healthcare pricing information more accessible for consumers, most states still receive an F grade, according to the third annual Report Card on State Price Transparency Laws.

Christine K. Cassel, MD, president and CEO of the National Quality Forum, sent her best wishes to The American Journal of Managed Care for its 20th year anniversary in publication.

When The American Journal of Managed Care's ACO and Emerging Healthcare Delivery Coalition met for the most recent Web-based session, the speakers discussed the importance of accountable care organizations as CMS moves forward with new reimbursement schemes and managing high-risk patients through coordinated care.

Margaret E. O'Kane, president of the National Committee for Quality Assurance will join The American Journal of Managed Care for a Tweetchat on June 26 at 1 pm EST. Follow the discussion and ask your own questions using #AJMCchat.

Among the 20 chronic conditions with the highest impact on the Medicare population, some have no quality measure, which limits Medicare's ability to pay for value.

Concepts from the patient-centered medical home model can offer answers to giving the newly insured a place to find care outside of the emergency department setting.

Aledade, founded by Farzard Mostashari, MD, announced on Monday that it had raised $30 million to support its mission of partnering with independent primary care physicians to create accountable care organizations and further fuel the company's growth.

Integrating behavioral health care into the space where care for diabetes occurs can be aided by new delivery models and by technology, panelists say.

Arkansas has implemented multi-payer payment reform incorporating both episodic and Patient-Centered Medical Home models. Early perceptions of a sample of stakeholders were largely positive to date.

Multiple factors can impact the effectiveness of financial incentives intended to encourage primary care providers to improve patient experiences.

In the keynote presentation at Patient-Centered Diabetes Care 2015, Robert A. Gabbay, MD, PhD, discusses how new payment models can improve care in both type 1 and type 2 diabetes.