Value-Based Care

Personalized medicine will be expensive in these early days of pioneering and planning. But individual genomic testing is not going to be exorbitant forever — and the ROI is gonna be big, both in patient outcomes and dollars saved.

When it comes to value-based decision making, several factors can influence physician behavior. Although many organizations rely on financial incentives, the Commonwealth Fund argued in a report released Tuesday that healthcare leaders should think beyond the dollars and dimes.

More than 8 million Americans have signed up for health insurance thanks to the Patient Protection and Affordable Care Act. Significantly increasing access to care, the 4-year-old healthcare reform law also creates incentives for providers to reorganize the delivery of healthcare.

It is well known that oncology care pathways are the tools that practices can utilize to care for its patients. Ira Klein, MD, MBA, FACP, chief medical officer, National Accounts Clinical Sales & Strategy, Aetna, suggests that Aetna's only involvement in creating these pathways should be in helping these practices develop "reasonable care pathways."

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, hosted a recent Web-based session that featured three presentations on aspects of the transition to value-based care: why barriers to change persist, what steps one ACO is taking to drive better health, and why a "patient-centered" method of picking a doctor makes sense.

The National Committee for Quality Assurance (NCQA) proposed a program that would integrate patient-centered medical homes (PCMHs) with nontraditional ambulatory sites. If adopted, the program would assess the quality of care delivered at practices such as ambulatory care, urgent care centers, retail clinics, and worksite clinics.

Physician employment contracts with hospitals that were signed in the early days of healthcare reform are coming up for renewal Experts say the expectation of payment reform requires that these new deals include the flexibility to adapt to expected and unforseeable changes.

Primary care doctors surveyed by the Medical Group Management Association say nearly 6% of their compensation was pegged to quality metrics in 2013, up from 3% in 2012.

Laurel Pickering, MPH, president & CEO of the Northeast Business Group on Health, explains that employers are transitioning employees into consumers with the help of "transparency tools" centered around price and quality.

Federal agencies remain committed to increase patients' access to affordable, high quality, and comprehensive healthcare.

The leaders of ACOs are working their way through a welter of immediate and longer-term issues.

HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015.

A CMS proposal would increase the number of quality measures that accountable care organizations (ACOs) would have to achieve under the Medicare Shared Savings Program in 2015.

Looking to control Medicaid costs, several states are launching accountable care initiatives that mirror experiments underway with Medicare and private insurers but vary significantly in their approaches.

The number of healthcare organizations participating in CMS's bundled payment program is expected to increase in upcoming weeks.

Panelists discussed the successes and failures associated with pathway implementation.

The panelists continued to discuss evidence-based medicine, as well as the incentives there might be to examine emerging and existing therapies or drugs.

In regard to updating pathways and guidelines, Dr Sonnad asked about the opportunity for newer, expensive immunotherapies to be included in a pre-determined pathway.

Panelists analyzed the concept of penalizing providers who deviate from pathway programs.

Dr Sonnad inquired how replacing brand drugs with generic equivalents can affect pathway adherence. She also asked panelist to discuss the differences between early-stage and late-stage disease regimens, as well as the degree of flexibility there is in regimen design.

In this segment, panelists discussed the various tools that are used to measure pathway adherence.

Dr Sonnad asked panelists about the participants on payer panels who determine the cost-effectiveness of pathways.

Geisinger Health System's use of a diabetes care system among high-risk patients produced lower risks of myocardial infarction, stroke and retinopathy over a three-year period, according to a study in The American Journal of Managed Care. Best of all, most of the benefit accrued in the first year of care.

In 2001, Maryland began to reimburse hospitals for excess volume at full case rates. The authors investigated the impact on hospital utilization and finances.

Providers recently reviewed the cost-effectiveness of accountable care organizations (ACOs). While half of surveyed providers said value-based reimbursement had potential to improve population health management, as well as the patient experience, 80% said it would require more staff, more time, and greater financial investments.

CMS stated that they seek recommendations about how the ACO program might evolve to "encourage greater care integration and financial accountability."

Paige Cooke, assistant director, customer engagement, National Committee for Quality Assurance, says that primary care practices cannot effectively deliver patient-centered care without coordinating a patient's care across different healthcare settings.

The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.

Accountable and patient-centered care delivery models were at the forefront of discussions among coalition members.

A growing body of evidence is demonstrating how the benefits of Connected Care, electronic communication between patient and caregiver, are improving healthcare access and quality and reducing costs for payers-without passing through Congress.