Value-Based Care

Optimal end-stage renal disease (ESRD) starts were associated with lower 12-month morbidity, mortality, and inpatient and outpatient utilization in an integrated healthcare delivery system.

As the term “value” has become a norm in healthcare, specifically in oncology, panelists at a National Comprehensive Cancer Network policy summit offered perspectives on where we are now in delivering high-quality cancer care under value-based payment models.

CMS implemented the Categorical Adjustment Index as part of the Medicare Advantage and Part D Star Rating Program in 2017. These analyses informed its development. Check out our website’s new table/figure pop-up feature! Click on the name of a table or figure in the text to see it in your browser.

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 stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms the value of daily aspirin for patients with diabetes.

Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, explains how her organization is helping employers better understand accountable care organizations (ACOs) and judge how the ACO model might work with their population.

In 2016, the Next Generation Accountable Care Organization (ACO) model generated a net savings of $62 million to Medicare, representing a 1.1% net reduction in Medicare spending. In a webcast with the Accountable Care Learning Collaborative, CMS Administrator Seema Verma called the results a strong start and offered a look at what's in the future for the model.

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 panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work.

Physician- and nursing staff–reported team functioning was associated with patient satisfaction but not with clinical quality or patient portal implementation.

Providing patient-centered comprehensive care to long-term cancer survivors may lead to reduced total healthcare expenditures. Check out our website’s new table/figure pop-up feature! Click on the name of a table or figure in the text to see it in your browser.

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.

Robert A. Gabbay, MD, PhD, FACP, chief medical officer and senior vice president at Joslin Diabetes Center, said health systems need people with the skill sets that diabetes educators possess to make the transition to a reimbursement system based on quality, prevention, and eliminating costs.

Accountable care organizations (ACOs), either directly or indirectly, are affecting physician employment patterns in regions where they have high penetration.

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

This 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.

When physicians follow computer alerts embedded in electronic health records, their hospitalized patients experience fewer complications and lower costs, leave the hospital sooner and are less likely to be readmitted, according to a study of inpatient care.

This analysis examines the associations between adherence to Choosing Wisely recommendations embedded into clinical decision support alerts and 4 measures of resource use and quality.

The first in a series of articles that identifies CMS' goals in updating the Medicare Shared Savings Program and how well the proposals make taking on more risk appealing for accountable care organizations.

Following CMS’ announcement of a proposed rule to overhaul the Medicare Shared Savings Program, the National Association of ACOs (NAACOS) released a statement, saying the move will “upend the ACO [accountable care organization] movement by creating havoc with a significant overhaul introducing many untested and troubling policies.”

The share of Medicare Advantage (MA) beneficiaries in the nursing home (NH) population has been steadily rising, while MA plans appear to be increasingly concentrating beneficiaries in select NHs with better performance on quality measures.

Hospital leaders are concerned about how to get ready to take on more risk, said Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health.

Despite the presumption that larger practices that have more resources and are therefore better at providing care and improving outcomes, new research shows that they spend more on and have higher readmission rates for Medicare beneficiaries than smaller practices.

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 stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.

We examine utilization, quality, and expenditures among Medicare beneficiaries receiving care at federally qualified health centers and compare outcomes among those attributed to 1 of 3 recognition programs versus none.

The implementation of alternative payment models that successfully capture clinical heterogeneity—without adding unacceptable levels of administrative complexity—may be equally (if not more) important than site-neutral payment policies.

After 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.

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.

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.