Value-Based Care

In Hennepin County, Minnesota, the local government has gotten into the business of healthcare and linked a variety of services into an accountable care organization (ACO) model that not only addresses beneficiaries' health needs, but also their social determinants of health, explained Ross Owen, health strategy director of Hennepin County..

The FDA has been willing to explore the utilization of surrogate endpoints like tumor response in clinical trials, but it is unclear whether these endpoints correlate with overall survival, said David Fabrizio of Foundation Medicine, Inc. However, he emphasized that overall survival does not necessarily benefit the patient if the additional days gained are not quality days.

Patients are becoming more engaged in their own healthcare, meaning they have more input in the quality measurement process and can even help develop quality measures for the future, said Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council.

Underinsurance, which occurs when people have insurance but aren't covered for services they need, is a serious problem in the US, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan. He proposed some strategies to alleviate this phenomenon, like smarter deductibles and revised Internal Revenue Service (IRS) rules.

Patients with rare diseases often turn to the Internet for information on their illness, but an analysis of some of these websites found that their content often failed to meet important quality criteria and neglected key information categories.

Researchers have found that accountable care organizations with a higher proportion of minority patients tend to score worse on Medicare’s quality performance measures.

CMS understands that not all physicians will report quality measures under the Medicare Access and CHIP Reauthorization Act or join advanced alternative payment models, especially immediately, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. However, there are efforts in place to make it as easy as possible for these providers, which will hopefully increase participation over time.

Physicians have shown great interest in understanding how to transition into value-based processes, especially with the new rules under the Medicare Access and CHIP Reauthorization Act (MACRA), said Roy Beveridge, MD, chief medical officer of Humana. While these transitions take time and effort, they eventually lead to physicians being reimbursed more for longer visit times and improved outcomes.

More hospitals are switching to employment-based affiliations with physicians, but a recent analysis found no association between conversion to an employment model and changes in mortality, readmissions, length of stay, or patient satisfaction rates.

At the fall live meeting of The American Journal of Managed Care®'s ACO & Emerging Healthcare Delivery CoalitionTM, speakers discussed how to care for complex patients, and the latest in reimbursement.

A glimpse at the top 5 articles from The American Journal of Managed Care's® conference coverage that caught reader attention in 2016.

Gathering patient-reported outcomes and experiences is essential to evaluating the success of bundled payment models, said Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Contributors to AJMC.com bring fresh insight from their real-world experiences to discuss important subjects in managed care, which this year included topics like accountable care organizations, telehealth, and urgent care prescribing. Here are the 5 most-read articles from our contributors in 2016.

This week, the top managed care stories included CMS announcing more mandatory bundled payment models and a new track in the Medicare Shared Savings Program, the FDA approving a new use for Dexcom's continuous glucose monitor, and a greater emphasis on lifestyle management in the American Diabetes Association's care standards.

With the Medicare Access and CHIP Reauthorization Act (MACRA) set to take effect January 1, 2017, The American Journal of Managed Care has created a resource center, the MACRA Compendium, where payers and providers can find updates on the transition to value-based care.

Understanding the perspectives of clinicians and administrators who are leaders in implementing patient-centeredness in accountable care organizations can help point the way toward implementation by others.

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.

CMS is moving full-steam ahead with the transition to value-based care. On Tuesday, the agency announced 3 new bundled payment models in cardiac care, an expansion on the Comprehensive Care for Joint Replacement Model, and the highly anticipated new track in the Medicare Shared Savings Program.

Along with the peer-review research, journal articles, and news coverage, The American Journal of Managed Careâ„¢ (AJMCâ„¢) has a robust multimedia component that brings together stakeholders from across the healthcare industry to discuss important topics in the world of managed care and delve deeper into topics.

What we’re reading, December 20, 2016: Purdue Pharma, which makes OxyContin, plans to expand its sales of the drug in foreign markets; family members blame hospital for not warning them about low-quality nursing home; a project to place blast sensors on soldiers to learn more about concussions has been discontinued.

CMS must learn from implementation of new quality measure sets as it refines and expands the Core Quality Measure Collaborative, Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Integrating behavioral and physical health services within an accountable care organization offers a significant opportunity to address both behavioral health conditions and substance use disorders, as well as to improve outcomes and reduce costs.

Recent election results raise questions about the future of healthcare programs and the coordination of patient care in our nation.

A new accountable care organization (ACO) model announced by CMS aims to improve care and lower costs by allowing beneficiaries enrolled in both Medicare and Medicaid to be covered under a Medicare Shared Savings Program ACO.

The authors describe best practices for Web design in the accountable care organization space in order to enhance engagement with patients and providers.

The Department of Veterans Affairs healthcare system has announced a final rule that will grant full practicing authority to some types of advanced practice registered nurses, with the exception of nurse anesthetists.

The Delaware Valley Accountable Care Organization (ACO) was disappointed to learn that under CMS’ Medicare Access and CHIP Reauthorization Act (MACRA) final rule, the practice would not be categorized as an advanced alternative payment model (APM) and would likely have less of an upside under the Merit-based Incentive Payment System (MIPS), said Katherine Schneider, MD, president of the Delaware Valley ACO. However, Dr Schneider said she understands CMS’ point of view and why it needed to make changes to the final rule.

Hospitals participating in accountable care organizations (ACOs) have greater adoption of health information technology, particularly patient-facing technology and health information exchange, than non-ACO hospitals.

Diabetes educators are well-positioned to help accountable care organizations meet their business, healthcare, and financial goals. The emphasis on primary care in treating chronic disease calls for an increased emphasis on diabetes educators to achieve better healthcare outcomes in a cost-effective manner.