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
Tim Gronniger on Challenges With Implementing New Payment Models
August 23rd 2018Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health, discusses the struggles that organizations face when attempting to make a switch to new payment models, and how that switch can be improved in the future.
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This Week in Managed Care: August 17, 2018
August 17th 2018This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.
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ASCO: Proposed Medicare Payment Changes Could Hurt Quality Cancer Care
August 12th 2018A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program and the proposed 2019 Medicare Physician Fee Schedule could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology.
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BPCI Participation Not Linked With Significant Changes in Payments or Readmission
August 5th 2018A new study found hospital participation in 5 common medical bundles under the Bundled Payments for Care Improvement initiative was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality.
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Employer Support Is Needed to Help Payment Reform Succeed
August 5th 2018Payment reforms efforts are still facing barriers, but buy-in and increased demand from self-insured employers can help spur widespread adoption of new payment models that will lead to health delivery system reforms, according to a commentary published in New England Journal of Medicine.
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Oncology Care Model Not Immune to the Need for Intervention
July 31st 2018With the evaluation period for the Oncology Care Model at its midway point, there is an opportunity to discuss how the program and other bundled payment programs can better deliver on aims to provide higher quality care at the same or lower cost.
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Oncology, CVD, Infectious Disease Most Common Areas for Outcomes-Based Contracts, Avalere Finds
July 27th 2018Health plans continue to show interest in expanding outcomes-based contracts, according to an Avalere Health study that also found cardiovascular diseases, infectious diseases, and oncology represent the most common therapeutic areas to have these contracts.
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Azar Appoints Senior Advisor for Value-Based Care in the United States
July 24th 2018Adam Boehler, director of the Center for Medicare & Medicaid Innovation, is taking on an additional role as the senior advisor for value-based transformation and innovation. He represents the last departmental appointment as part of HHS Secretary Alex Azar's 4 priority areas.
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Report Provides Snapshot of Cancer Clinic Performance in Washington State on Quality and Cost
July 18th 2018After 5 years of research, the Hutchinson Institute for Cancer Outcomes Research has released a report that is the first in the nation to publicly report clinic-level quality measures linked to cost in oncology.
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ACOs With Risk-Bearing Experience Are Likely Taking Steps to Reduce Low-Value Medical Services
Experience with risk-based contracting best predicts active engagement of accountable care organizations in reducing low-value medical services, mainly through physician education and encouraging shared decision making.
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Doctors, Payers Think Transition to Value-Based Care Has Slowed, Survey Says
July 17th 2018The shift to value-based care has stalled since 2017, according to a survey of health plan executive and providers commissioned by Quest Diagnostics. Quest said its third annual study suggests that physicians need better tools, like data access, and less complex quality measures to spur adoption of value-based healthcare, which focuses on care quality and patient outcomes rather than the quantity of services delivered.
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The Evolution of Quality Measurement and Efforts to Streamline Reporting
July 17th 2018Quality measurement has been around for nearly 2 decades and in that time measures have evolved and also proliferated to the point of placing considerable burden on physicians and health systems. New efforts are being made to streamline current measures, fill in gaps, and harmonize measures across programs.
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Forgotten Patients: ACO Attribution Omits Those With Low Service Use and the Dying
This article compares clinical and utilization profiles of Medicare patients who are attributed to provider groups with those of patients unattributed to any provider group in accountable care organization models.
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Comparing Characteristics of Hospitals Participating in Medicare's BPCI With Nonparticipants
July 15th 2018A study found that hospitals participating in Medicare’s Bundled Payments for Care Improvement and hospitals not participating are dissimilar in meaningful ways that limit the generalizability of the program's results.
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This Week in Managed Care: July 13, 2018
July 13th 2018This week, the top managed care stories included additional moves by the Trump administration to unravel the Affordable Care Act; Pfizer canceled a round of drug price increases after speaking to the president; advocates for 340B sound the alarm on efforts to reform the program.
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Challenges in Previous Incentive Programs Will Continue Under MIPS for Small, Rural Practices
July 12th 2018While small and rural practices will likely perform better in the Merit-based Incentive Payment System (MIPS) than they have in previous programs, they will still be outpaced by larger practices. Stakeholders also outlined challenges they think will likely continue for these practices under MIPS.
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This Week in Managed Care: July 6, 2018
July 6th 2018This week, the top managed care stories included a federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action.
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A Blueprint for Building Better Maternity Care Payment Systems
July 3rd 2018In the United States, too many of our mothers are dying during and after childbirth. Costs of childbirth care are high for everyone—for health plans, for taxpayers, and for families. We are moving in the wrong direction, and it is well past time to change course.
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