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What We're Reading: Walmart and Value-Based Care; Humana's Strategic Shift; Physician Group Seeks APM Bonuses
Walmart will launch a pilot value-based care program in January 2020; Humana is positioning itself from “an insurance company with elements of healthcare to a healthcare company with elements of insurance"; efforts are paying off to get an answer from CMS about delays in bonus payments due to doctors who take part in alternative payment models (APMs).
Retail Giant to Use Performance Measures to Guide Employees’ Physician Selections
Walmart will launch a pilot value-based care program in January 2020 that the retail giant said is designed to help its employees who have health coverage find physicians who deliver high-quality care. Dallas-Fort Worth, Texas; Orlando and Tampa, Florida; and Bentonville, Arkansas, where the company is based, will be the test regions where physicians will be identified by performance measures created by Nashville-based Embold Health. According to the Dallas Morning News, physicians will be selected for 8 specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics, and pulmonology.
Humana Official Tells Group That Insurer Is Becoming a Healthcare Company
Vishal Agrawal, the chief strategy officer and corporate development officer for Humana, told an audience at CB Insights’ Future of Health in Manhattan on Wednesday that the insurer is positioning itself from “an insurance company with elements of healthcare to a healthcare company with elements of insurance,” according to a report from Fierce Healthcare. Agrawal cited elements such as Humana’s mail order pharmacy, more than 230 owned or allied primary care clinics, and its home healthcare provider. He said the insurer is making greater use of technology and working to address social determinants of health, which research shows play an outsize role in patient outcomes.
CMS Says APM Bonus Payments Will Be Going Out Soon
The American Academy of Family Physicians (AAFP) reported in a blog post that its efforts are paying off to get an answer from CMS about delays in bonus payments due to doctors who take part in alternative payment models (APMs), which are the heart of the transition to value-based care under the 2015 Medicare Access and CHIP Reauthorization Act. The post said AAFP and other physician groups wrote to CMS Administrator Seema Verma September 16, 2019, asking why no bonus payments due had been paid with the end of the third quarter approaching. Verma replied September 27, 2019, that payments are coming soon and that in future years payments should arrive no later than June 30. The payments due are tied to performance for 2017. Physicians warned that if delays are the norm, practices will be reluctant to take part in APMs.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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