Health Care Cost

Providers' perspectives point to key considerations for policy makers as they seek to broaden participation in the Bundled Payments for Care Improvement Initiative.

Public comments on the first ever update to the Medicare Shared Savings Program are in. Conceptually, there is an astounding level of consensus, but it is the details that can make or break an ACO.

The time is now for primary care physicians to take a proactive approach in ensuring safety as a means of attaining accountability.

Until recently, it's been unclear whether accountable care organizations can live up to the hype or are just a passing healthcare reform fad.

New proposals from Congress would decrease Medicare payments to hospital outpatient departments, which traditionally serve patients who are more likely to be minority, poorer, and have more severe chronic conditions compared with patients treated in physician offices.

Suzanne F. Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, will be the keynote speaker at the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held April 30 and May 1, 2015, in San Diego, California. The ACO Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across the healthcare spectrum interested in sharing best practices relative to the changing delivery and payment models.

A one-minute look at managed care news during the week of February 23, 2015, including another step by CMS toward a quality-based payment system and more predictions on the outcomes of King v. Burwell.

Proposed payment cuts to Medicare Advantage (MA) could cause many beneficiaries to lose access to MA plans and cause great disruption to the market, according to a new report by Oliver Wyman for America's Health Insurance Plans.

The goals of the new CMS Oncology Care Model align very nicely with what payers want, according to Ira M. Klein, MD, MBA, FACP, national medical director, clinical thought leadership, office of the chief medical officer, Aetna.

Amidst changes in healthcare financing and delivery, health plans and providers need to be revising their business models to remain profitable, according to Avalere's healthcare industry outlook for 2015.

The National Association of Accountable Care Organizations has teamed up with physicians, hospitals, medical associations, and almost all Medicare Shared Savings Program accountable care organizations in the country to pen a 36-page letter to CMS.

The Obama administration's push to transform the way the US pays for healthcare is splitting the medical profession, as family doctors embrace changes that oncologists, neurologists and other specialists are concerned will cause turmoil.

A new private-sector alliance of healthcare systems and payers will dedicate to accelerate the US healthcare system's transition to value-based models aligned with improving outcomes and lowering costs.

A new health policy issue brief from the Brookings Institution has outlined specific modifications that would enable to legislation in Congress to support better care and more value in Medicare.

Highly-paid doctors make more money ordering multiple procedures for individual patients than they earn seeing multiple patients, suggesting payment reform under the Affordable Care Act has yet to be realized.

ASCO has been working in parallel with various other institutions to generate a patient-centered oncology payment reform model.

Implementation of payment reform, without a corresponding change to coverage, benefit, and other payment requirements, creates conflicting incentives that may nullify the intended aim of payment reform: to improve health outcomes, while saving costs.

Robert Gabbay, MD, PhD, discusses the changes he wishes to see in the healthcare system that he calls a "journey toward quality," and with his work at the Joslin Diabetes Center, he dreams of ridding the world of diabetes by implementing innovation.

A federally funded effort to identify high-risk patients and coordinate their care is delivering modest savings, but significant cost reductions may come only after broader payment reforms take hold.

Highlights from recent AJMC conference coverage.

As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers?

Session highlights from the Managed Markets Summit in Orlando, FL, February 25-27.

Health information technology (HIT) was the focus of a discussion led by Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for HIT, US Department of Health and Human Services. In his Managed Markets Summit 2014 keynote address, Health IT and Reform: The Road to Right Care, Dr Mostashari touched upon the obstacles and shortcomings in our nation's healthcare landscape, and asserted that more prominent usage of HIT would help to alleviate fiscal concerns and affect better outcomes in patient care.

Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for health information technology (HIT), US Department of Health and Human Services, says we need to have payment reform to support the success of HIT.

Oncology clinical pathways have helped health plans deliver quality care while keeping an eye on costs. The lack of standardization in pathways can be cumbersome on a busy oncology practice. If Medicare adopts a pathways model, it could offer a framework for broader use.

Nearly half of the organizations in the CMS' largest test of accountable care slowed Medicare spending, but just 29 of 114 ACOs saved enough to receive bonus payments, the agency said.

Moving healthcare reimbursement from fee-for-service to a system that rewards quality care is easier said than done, but tools are emerging to help the cause. Three expert commentators featured in the inaugural issue of The American Journal of Accountable Care examined the challenges providers face, as they are being ask to share risk under new contracts with accountable care organizations, or ACOs.