Policy

While rapid innovations in the field of oncology have improved treatments, the magnitude and dimension of clinical benefits vary widely.

Cancer care and its associated costs can combine with everyday bills to create a significant financial burden, especially for young adults with cancer, said Samantha Watson, founder and CEO of The Samfund.

The kind of data oncologists need to move towards value-based care isn’t easily accessible in patient electronic health records, but new platforms like Cancer Outcomes Tracking and Analysis (COTA) are trying to make it easier, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Among Michigan primary care practices, sustained participation in a pay-for-value program appears to contribute to improved utilization outcomes for high-need patients.

This year, the most read articles from The American Journal of Accountable Care® explored how healthcare providers and payers have implemented innovative ideas to reduce spending while maintaining or increasing the quality of care.

A case study of an innovative model for wound care suggested that an integrated approach to healing wounds could result in decreased costs of care and length of hospital stay.

A recent study that conducted interviews with mainly Latino residents of agricultural communities in California found that most considered affordability, not access, a major barrier to buying healthy foods.

The new era of data informatics tools can help providers and payers understand the tiers of risk that determine the economics of care delivery, which is crucial to value-based cancer treatment, according to Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology

What we’re reading, December 16, 2016: consumers now have until December 19 to enroll in a marketplace plan for coverage starting on January 1; 20 states file lawsuit against 6 pharmaceutical companies alleging generic price fixing; women who were tested for the BRCA mutation gene after Angelina Jolie’s announcement may not have been at high risk to begin with.

The authors illustrate a methodology for delineating variations in medical costs for patients with similar clinical conditions and needs using electronic health record data.

As the healthcare industry continues its transition toward value-based care, some medical ethicists have raised concerns about how education with an emphasis on value can potentially conflict with patients’ best interests. An opinion letter published in JAMA discusses various strategies for addressing these tensions.

An analysis of per capita Medicare spending among beneficiaries with 6 or more chronic conditions reveals wide geographic variations in costs across the US, with similar spending levels often seen in counties neighboring one another.

The amount of Americans under age 65 in families having trouble paying medical bills has dropped significantly over the past 5 years, according to a survey report from the National Center for Health Statistics. The percentage of children in families that struggle to pay healthcare bills has steadily declined as well, though as of June 2016 it remained higher than the percentage of such adults.

Oncology is a perfect fit for the bundled payment model, because it evaluates the outcomes, patient satisfaction, and cost of an oncology episode, said Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ. She said that Horizon adopted the bundled payment model early to cope with New Jersey’s rising healthcare costs.

A review of our peer-reviewed research in the healthcare and mainstream press.

This paper presents a policy proposal to integrate care for Medicare beneficiaries through creation of integrated care organizations and a Medicare home care benefit.

Using precision medicine to implement clinical decisions can help healthcare providers achieve the triple aim, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

After CMS released its proposed rule for the Medicare Access and CHIP Reauthorization Act, it received overwhelming feedback from clinicians that spurred the agency to make a number of changes for the final rule, according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Hospital consolidation is a common practice, but its benefits can often be accomplished through other mechanisms, said Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

As the healthcare industry continues its transition towards alternative payment models (APMs), some providers might feel apprehensive about keeping up with new requirements like those in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. However, these providers can use healthcare information technology (IT), data analysis tools, and other resources to adapt to these changes, according to Suzanne Travis, vice president of regulatory strategy at McKesson.

Among the measures on the ballot for Californians this Election Day is Proposition 61, the Drug Price Standards Initiative. The measure, which would restrict the amount state agencies pay for drugs, has a multitude of supporters and opponents who have amassed a combined $125.84 million in contributions as of Monday.

Medicaid programs provide hepatitis C treatments to needy patients despite the high price, said Matt Salo, executive director of the National Association of Medicaid Directors. He is optimistic that having more manufacturers in the market will bring costs down and make treatment more accessible for all.

When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations.

Employers face tough decisions about rising costs, high-quality care, coordination of benefits, and workplace accommodations when employees are diagnosed with cancer, but they will always want to support those employees as best they can, according to Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health.

A home-based palliative care (HBPC) program tested within an accountable care organization (ACO) demonstrated substantial cost savings and reduced hospital admissions for patients near the end of life, according to a Journal of Palliative Medicine study.

Many institutions and researchers responded to the PAN Challenge call for papers last year, and even more are expected this year, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation. He emphasized that this year’s Challenge is especially important because it can help reduce the financial hardships that many cancer patients often face.

The rate of inmates infected with the hepatitis C virus is estimated at 17.4% across the United States, and can reach as high as 40% in some states. However, many inmates in state prisons are not permitted to receive the the newest and most expensive treatments for the virus.

“Healthy Steps for Older Adults,” the Pennsylvania Department of Aging’s falls prevention program, resulted in savings of $718 to $840 per person.

Nineteen percent of bills for out-of-network visits were negotiated, and of these negotiated bills, individuals were successful in lowering their costs approximately half the time.

The cost of an intravenous drug used to treat lead poisoning has skyrocketed after a 2700% price increase by Valeant Pharmaceuticals. Experts worry that its high price and the lack of alternatives will place it out of reach for hospitals that need it. This is not the first time Valeant has been criticized for its price-raising practices.