February 23rd 2024
While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.
February 14th 2024
Maine Insurer Sues HHS Over CSR Payments
January 11th 2018Maine Community Health Options is seeking $5.6 million from HHS, claiming the department failed to reimburse marketplace insurers for cost-sharing reductions for 2017. Under section 1402 of the Affordable Care Act, an insurer participating in the marketplace is required to offer CSR plans, and in return will be guaranteed reimbursement by the government.
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Dr Roger Brito: What Patients Should Know About Alternative Payment Models, OCM
January 9th 2018The healthcare triangle (patients, payers, and providers) begins with the patient, so we should include the patient in some of the decision-making, said Roger Brito, DO, national director for oncology, Aetna.
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Modernizing the Stark Law Will Improve Care for Medicare Patients and Lower Costs
December 28th 2017Curbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.
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What We're Reading: Hospital Penalization; New APMs; EHR Challenges
December 26th 2017More than 700 hospitals were penalized for having the highest rates of patient injuries; the Physician-focused Payment Technical Advisory Committee backed 2 new alternative payment models; and experts outline the biggest challenges of implementing and maintaining electronic health records going into the new year.
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CJR Voluntary Participation—Should I Stay or Should I Go?
December 11th 2017This article focuses on the financial results that may accrue to a participating hospital throughout the remainder of the Comprehensive Care for Joint Replacement program as a result of the migration from historical baseline to regional target rates, and rebasing of the historical baseline.
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Dr Lucio Gordan: Improving Population Health Through Alternative Payment Models
December 8th 2017As people get more empowered and more informed with data, such as their own electronic medical records, they will utilize the information to do better for themselves and improve their health, said Lucio Gordan, MD, of Florida Cancer Specialists.
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Dr Ira Klein on Pharmaceutical Interest in Alternative Payment Models
December 7th 2017Pharmaceutical companies would like to see value-based contracts that are multi-year and over large populations, said Ira Klein, MD, MBA, FACP, senior director of healthcare quality strategy for the Strategic Customer Group at Janssen Pharmaceuticals.
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Transitioning Community Hospitals to Value-Based Care: Lessons From Massachusetts
This article examines the evolution of the Community Hospital Acceleration, Revitalization and Transformation investment program in Massachusetts and informs other states seeking to transform care delivery in community hospitals toward value-based care.
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CMS Finalizes Changes to Joint Replacement Bundles; Verma Promises Shift to Voluntary Models
December 1st 2017Scaling back the Comprehensive Care for Joint Replacement model and canceling an expansion proposed under the Obama administration represents a shift in philosophy from mandatory to voluntary bundled payment models. But some say that commercial payers and employers will demand change no matter what CMS does.
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How Has the OCM Evolved? Year 1 Provider Updates
October 24th 2017Participants from 2 oncology community practices—an oncologist–administrator combination—shared their experience with implementing the Oncology Care Model (OCM) with attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.
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Federally Qualified Health Centers Prepare for Challenging Path Ahead
September 20th 2017Federally qualified health centers face significant financial and competitive pressures, but executives reported in a recent survey that they have identified areas for improvement and are planning a path to success.
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MACRA Survey Finds Oncology Physicians Unprepared for Payment Changes
September 12th 2017A recent survey conducted by Integra Connect has found that a majority of specialty physicians have not yet invested in operational changes that may be essential for their success under value-based care reimbursement models.
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Dr Zirui Song Discusses Early Effects of Payment Reform on Physician Behavior
July 1st 2017Public and private payment reforms such as accountable care organization contracts have shown some initial evidence of changes in physician behavior, but their full promise remains to be seen, according to Zirui Song, MD, PhD, resident at Massachusetts General Hospital.
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Developing a Creative Strategy to Present the Value of Oncology Drugs
June 22nd 2017At the 8th Annual Oncology Market Access & Pricing USA 2017 meeting hosted by eyeforpharma, Sriram Shankar, senior consultant, INC Strategy Consulting, shared his thoughts on the implications of value frameworks for payer strategy.
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AMA Chooses Oncologist Dr Barbara McAneny to Lead as President-Elect
June 13th 2017The American Medical Association (AMA) has announced its choice of Barbara McAneny, MD, to lead as president-elect, making her the first oncologist to take the reins of the nation’s largest physician organization.
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Allison Silvers on Payment Model Flexibility in Palliative Care
May 14th 2017Fee-for-service payment models have not been successful in the field of palliative care, where small practices seem to work better under flexible programs like per member per month, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.
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Making Sense of Advanced Payment Models
April 19th 2017The American Society of Clinical Oncology has developed the Patient-Centered Oncology Payment (PCOP) model with the hope that PCOP will be accepted by CMS as an advanced alternative payment model, and become available to medical oncologists as an alternative to the Merit-based Incentive Payment System.
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Why Oncologists Need Technology to Succeed in Alternative Payment Models
April 19th 2017The emergence of alternative payment models, as exemplified by the Oncology Care Model, is requiring oncologists to develop new solutions to meet the requirements of these programs. Technology available at the point of care offers an efficient solution to many of the most labor-intensive processes.
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How to Create Successful Alternative Payment Models in Oncology
April 17th 2017By identifying ways to improve cancer care and then designing alternative payment models (APMs) to overcome current payment barriers, APMs can enable oncology practices to deliver better care to patients and save money for payers in a way that is financially sustainable for the practices.
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Beneficiary Engagement in Medicare's Alternative Payment Models: From Serendipity to Active Choice
March 10th 2017This article explores elements of patient and consumer engagement implicated by Medicare’s alternative payment models, emphasizing the potential for shopping and use of cost information.
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Dr Harold L. Paz Discusses Aetna's Vision for the Future of Value-Based Relationships
March 7th 2017As healthcare increasingly rewards quality and value in care delivery, Aetna hopes that 75% of its payments will be value-based by 2020, according to Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.
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Integrating Patient-Centered Outcomes in APMs
February 22nd 2017As payment models shift to emphasize patient experience and quality of care, a panel discussion at the 5th annual Patient-Centered Oncology Care® meeting debated whether these efforts had meaningfully improved outcomes for patients.
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Advanced APMs and the Emerging Role of Immuno-Oncology Agents: Balancing Innovation and Value
February 16th 2017The shift to value-based care, concurrent with innovations in immune-based care, will create challenges in oncology. What should be the physician and manufacturer responsibility during these changing times?
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Implementing Alternative Payment Models: Just Do It, Advocate Panelists at AcademyHealth
February 7th 2017Payment reform in the United States has been going on for years, and a panel at the AcademyHealth National Health Policy Conference analyzed how much progress has been made to move away from fee-for-service, and what the evidence on alternative payment models has found.
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