Insurance

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

The lag time between the end of a performance period in the Oncology Care Model (OCM) and the release of the full report from CMS, represents a challenge for practices looking to improve.

CMS is moving home health agencies away from a volume-based payment model and to a new value-based payment system. The Patient-Driven Groupings Model would focus on patient needs and rely more heavily on patient characteristics in order to pay for home health services.

The proposed changes to the Medicare Shared Savings Program may put a damper on the accountable care organization (ACO) movement, but ACOs remain the government’s best option for controlling healthcare costs, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

There are some proposed changes to the Medicare Shared Savings Program (MSSP) that may be favorably or not depending on the accountable care organization (ACO) and its situation, said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

“Super-utilizers,” meaning patients with complex health issues and frequent hospital visits, are becoming a focus of care management programs in an effort to improve patient outcomes. A study published in The American Journal of Managed Care®, and featured on our next Managed Care Cast podcast, found that Medicare fee-for-service patients in four states who fit this category and were enrolled in a high-intensity care management program had 37 percent fewer unplanned hospital readmissions.

In the keynote address at Patient-Centered Oncology Care® 2018, Barbara McAneny, MD, a New Mexico oncologist/hematologist and the current president of the American Medical Association (AMA), shared her diagnosis for the current crisis in US healthcare, as well as a prescription—a new real-time oncology payment model led by physicians.

This month's issue of The American Journal of Managed Care® features a study that examined the effectiveness of a high-intensity, community-based care management program for Medicare patients with complex medical and social needs. We sat down with 2 of the study's researchers—Purvi Sevak, PhD, senior researcher at Mathematica, and Cara Stepanczuk, MPA, researcher in the health unit at Mathematica—to discuss the study findings and their implications.

The shorter timeline to risk and the reduction of shared savings rates are among the 2 greatest challenges accountable care organizations (ACOs) will face as part of the proposed changes to the Medicare Shared Savings Program (MSSP), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

While the proposed changes to the Medicare Shared Savings Program (MSSP) won’t mean a large number of changes to Coastal Carolina Quality Care, the accountable care organization will have to make some changes to respond to the new Enhanced track, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.

One of the big issues that policy makers need to pay more attention to is how to reform Medicare, which has about 10 years remaining until the baby boomers aging into the program now start to see increased medical costs and needs, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included a proposal to allow Medicare to pay the same prices for certain drugs as what other countries pay; President Donald Trump signed a law to fight the opioid crisis; an FDA advisory panel voted narrowly to retain a 10-year-old guidance for safety trials for diabetes drugs.

There are different ways to measure how Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have saved money, and the way used can drastically affect the amount of savings reported, explained Clif Gaus, ScD, president and CEO of the National Association of ACOs.

Systems, groups, and practices that haven’t yet joined the accountable care organization (ACO) movement will find it harder to do so if the proposed changes to the Medicare Shared Savings Program (MSSP) take effect, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.

Some of the proposed changes to the Medicare Shared Savings Program align with things the National Association of ACOs had been asking for, said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

President Donald Trump unveiled the latest steps his administration is taking to help Medicare drive down the costs of prescription drugs with a plan to allow CMS to determine the price it pays for certain drugs based on the prices that other countries pay.

Program audits are the chief tool used to evaluate how well health plans deliver care to an ever-growing share of Medicare's 60 million beneficiaries.

Approximately one-third of all US healthcare payments in 2017 were tied to alternative payment models, with the remaining still tied to fee for service. The findings of the Health Care Payment Learning and Action Network report highlighted that even as payments move to value-based models, more spending in models with risk is needed.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included the Trump administration unveiling plans to include drug prices in television ads; CMS touted Medicare Advantage at the beginning of open enrollment for Medicare; research found Medicare beneficiaries who live in housing with support services stay out of the hospital.

CMS Administrator Seema Verma touted the growth in enrollment in Medicare Advantage programs during an appearance at a conference run by America’s Health Insurance Plans on Tuesday.

By encouraging more providers to take on risk faster, the current administration may actually be disincentivizing providers from participating at all, which would reduce the number of accountable care organizations (ACOs), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

Private payers are getting more engaged in accountable care organizations (ACOs), said Clif Gaus, ScD, president and CEO of the National Association of ACOs.

Accountable care organizations (ACOs) have not had a significant impact on cancer care costs and utilization. While cancer care costs did decline from before the introduction of ACOs to after, there was no significant difference in spending decreases between ACO practices and non-ACO practices caring for patients with cancer.

The proposed changes to the Medicare Shared Savings Program that move accountable care organizations (ACOs) to take on risk in just 2 years is not going to be enough time for most ACOs, although some may be ready in that time, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Practices in the US Oncology Network received an average positive payment adjustment under the Merit-based Incentive Payment System (MIPS) of 1.90% for performance in 2017, and 99% of the Network’s physicians were in the top tier of performers. The maximum allowable adjustment is 2.02%. The adjustment based on a clinician’s performance in 2017 impacts the clinician's Medicare reimbursement for 2019.

Under the current administration, CMS has made several good-faith attempts to revitalize the current healthcare system. These efforts demonstrate CMS’ commitment to move our industry closer to value-based payment and consumer-centered delivery models. However, each of these reforms exhibits concerning characteristics.