Health Care Cost

Adoption of alternative payment models that reduce the number of visits to the emergency department could cause unintended consequences for emergency care through a reduction in revenue, according to researchers at the Brookings Institute.

The authors report on a conceptual "specialty ACO" design in cardiology in which cardiology-specific historic spending targets are created to capture cardiovascular disease—related reimbursement and a quality measurement system is introduced.

In its third year, Patient-Centered Diabetes Care, which took place April 16-17, 2015, in Boston, showed how new payment models, new therapies, and new approaches to patient engagement are changing care for persons with diabetes. The American Journal of Managed Care and Joslin Diabetes Center presented this year's meeting.

Pathways, particularly in oncology, have been gaining a lot more attention lately as payers are looking to bundle payments, Robert W. Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council, explained at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo in San Diego, April 7-10.

HHS Secretary Sylvia M. Burwell's announcement that CMS would move to value-based payments was a nail in the coffin for those skeptics who believed the push for value contracting would pass, according to Joseph Gifford, MD, chief executive of the Providence-Swedish Health Alliance.

The Health Care Payment Learning and Action Network kicked off with its inaugural meeting bringing together public and private sector actors to discuss efforts to move healthcare toward a system that pays based on quality rather than quantity.

Physician practices looking to engage in new healthcare payment models reported they need help and guidance to further advance delivery reforms, according to a joint study from the RAND Corporation and the American Medical Association.

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.