Value-Based Care

For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.

It is possible, if you lay the groundwork, to provide patients with acute leukemias with aggressive and effective therapies, while still allowing them to maintain quality of life, explained Jennifer Vaughn, MD, of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital.

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

This article analyzes the use of MRI in a national sample of patients with wrist pain before and after consensus guideline publication.

Through accountable care organizations, physicians are leveraging data and partnerships to create an efficient, quality-oriented system focused on improving patient outcomes and addressing health disparities.

No generalized statements regarding nurse practitioners’ low-value care ordering practices can be made due to limited evidence, indicating a need for further research.

For many patients with myeloproliferative neoplasms (MPNs) and myelodysplastic syndromes (MDS), their disease will be chronic, giving them a long-term cancer experience, said Jennifer Vaughn, MD, of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital.

At an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care® and Optum, speakers emphasized that innovation is urgently needed in primary care delivery to address the broken US health care system.

If we are to achieve the clinical and economic benefits of primary care and care continuity, the implementation and evaluation of strategies that reward clinicians and patients are warranted.

Experts discussed the Enhancing Oncology Model and themes in the movement toward value-based care in oncology during Patient-Centered Oncology Care 2023.

Health insurance enrollment through the Affordable Care Act (ACA) insurance marketplace has broken a record for the third consecutive year; attention-deficit/hyperactivity disorder (ADHD) treatment prescriptions for adults surged during the COVID-19 pandemic, contributing to lingering shortages; paying high rent can shorten your lifespan.

Kimberly Westrich, MA, of the National Pharmaceutical Council, explained how she envisions value assessment tools to be used in the US health care system in coming years.

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

In 2023, there were 18 oncology and 7 population health Institute for Value-Based Medicine® events cohosted with organizations such as Optum, OneOncology, Vanderbilt Ingram Cancer Center, Duke Health, Cleveland Clinic, and Memorial Sloan Kettering Cancer Center.

Top coverage from the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023 included sessions on value-based care implementation and best treatment practices.

Robert Groves, MD, of Banner | Aetna discusses the challenges primary care practitioners (PCPs) face when addressing social determinants of health (SDOH).

Patients seen at value-based care clinics received more preventive screenings and had lower risks of hospitalization and emergency room visits, according to Humana’s 10th annual value-based care report.

Michael Yim, MD, board-certified family physician, discussed the need for and logistics of collaboration between oncologists and primary care providers.

In an interview with The American Journal of Managed Care®, Grant Andres, BSc, DC, BSN, MSN-RN, senior director of clinical operations at Arizona Oncology, discussed the nuances of successfully implementing value-based care initiatives across a large organization.

Amitkumar Mehta, MD, MBA, University of Alabama at Birmingham, notes the long-term data and potential curative effects of chimeric antigen receptor (CAR) T-cell therapy, while expressing optimism about bispecific therapy with ongoing evolution and the chance of significant patient responses.

Edward "Ted" Arrowsmith, MD, MPH, medical director for pathways at OneOncology and managing partner at Tennessee Oncology, highlights the need for trust between payers and providers, as well as finding balance in building consistent clinical pathways while prioritizing specific practice needs.

Investigators propose potential payment models for gene therapies that consider equitable patient access and payer reimbursement.

There is a lot of noise in the health care system, and oncologists need to collaborate and decide on common shared goals, said Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

Leveraging technology intelligently can make the patient-doctor interaction much more seamless and connected, said Samyukta Mullangi, MD, MBA, medical director of oncology at Thyme Care, medical oncologist at Tennessee Oncology.

This 2022 survey of Medicare accountable care organizations (ACOs) shows significant growth in non-Medicare value-based contracts and in contracts with downside risk.

The Enhancing Oncology Model is trying to address a number of the systemic challenges oncology faces without giving practices the tools and resources they need, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.

Sophia Humphreys, PharmD, MHA, BCBBS, discusses highlights of the Institute for Value-Based Medicine® (IVBM) event, held in partnership with Providence Health System, that recently took place in Newport Beach, California.

Federal actuaries have projected what they believe to be health care spending through 2030-2031 in 9 important areas.