Interviews

CMS has taken steps to make clinical practice improvement regulations easier for independent practitioners to understand and achieve, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

A patient may be aware of the complications that could arise from a lack of adherence with a chronic disease like diabetes, but education is not enough to change a patient’s lifestyle, explained Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth.

ACOs have great potential in helping achieve a more value-based delivery system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation. She also discussed the challenges that safety net ACOs face in delivering care with fewer resources.

Clinicians may at first be confused by new value-based care regulations, but there are resources to help them understand, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Patricia Salber, MD, MBA, of The Doctor Weighs In, doesn’t believe the healthcare industry will become anything like that of the retail or travel industry, as healthcare is very complicated and consumers may not always be making their own decisions, especially in cases where patients are seeking hospital treatment.

Payment reform in the United States is moving quickly, but there are still a lot of unknowns among providers. Meetings like the ACO & Emerging Healthcare Delivery Coalition help accountable care organizations (ACOs) and providers share best practices and figure out how to succeed, said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and keynote speaker at the ACO Coalition's fall meeting in Philadelphia, Pennsylvania, October 20-21. Learn more about the meeting and register.

Data analytics used to be done in a retrospective manner, and physicians would be looking at the data long after the patient left his or her visit. Now, Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics, explained that her and her team have brought data diagnostics back into the physician’s workflow for easier and faster use.

Mark Lovgren, director of Telehealth Services at Oregon Health and Science University, described how the telementoring program Project ECHO fits into the university’s toolbox of telemedicine programs despite an initial learning curve.

The PAN Challenge is seeking long-term sustainable strategies to expand affordable access to care, which will benefit seriously ill patients the most, according to Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation.

Understanding the population a company serves is important in giving the individual what they want, said Jay Sheehy, senior vice president of product innovation at EmblemHealth. Fact-based information and consumer-oriented solutions are 2 strategies that Sheehy said healthcare companies could deploy to learn more about the consumer and in turn, better engage their customers.

Hospital consolidation has resulted in fewer choices for physicians and higher costs for patients, insurers, and taxpayers, according to Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

In terms of managing hospital readmissions, Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System, said that a hospital must not only consider the care given to a patient but the social situation he or she may be coming from.

While body mass index is a good indicator for obesity, there are various other factors and clinical symptoms that need to be taken into account when diagnosing and treating a patient for obesity, explained Ted Kyle, RPh, MBA, principal at ConscienHealth.

Medicaid programs must find a balance between confidentiality and patient safety when prescribing opioid painkillers, says Matt Salo, executive director of the National Association of Medicaid Directors.

The funds that the Patient Access Network (PAN) Foundation provides to patients are often used to help with the cost of medications, and there has been a large increase in the number of patients looking for assistance for the cost of cancer treatments, explained Daniel J. Klein, president and CEO of the PAN Foundation.

While working for Horizon Healthcare Innovations, Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, gained insights on how best to transition to a pay-for-outcomes system and was able to actively work with healthcare stakeholders who were engaging in these models.

CareSource is helping to bridge the gap in a patient’s care by working within that space to pull together the various stakeholders and put the patient’s care needs at the forefront of the conversation, said Karin VanZant, executive director of Life Services at CareSource.

Digital health programs like telehealth have already made progress in fields like mental health by expanding access and lowering costs, but there are opportunities to achieve much more in the future, according to Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

Personalized medicine looks at a patient’s genome, but precision medicine takes more of their social and individual determinants into account, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

CMS reached its goals for value-based payments in part because of providers’ enthusiasm for new programs, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

CMS' star ratings for hospitals have been controversial because they penalize hospitals that disproportionately care for the poor and the sick, and efforts by CMS to adjust the methodology haven't really addressed the concerns, explained Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.

The integration of data analytics into everyday use has allowed physicians to better engage in the patients care by intervening and taking action early, which ultimately improves quality of life and outcomes, said Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.

While Omada Health’s Prevent program is designed for individuals with prediabetes, it can be adapted to patients who already have diabetes, because the program is built on behavior change and modification, explained Mike Payne, MBA, MSci, former chief healthcare development officer at Omada Health.

The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

The commonly held perception of obesity as a personal failing on the part of the patient is outdated and unhelpful, said Janine V. Kyrillos, MD, FACP, of Thomas Jefferson University Hospitals and the Sidney Kimmel Medical College.

Ideally, the healthcare industry needs to be more consumer driven, so that solutions and programs are built with the patient in mind, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.

Since the implementation of the Affordable Care Act, more and more individuals are gaining access to insurance. Therefore, part of the New Jersey Health Care Quality Institute's responsibility is to make the complexities of the healthcare industry more easily understandable for members, according to Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute