Value-Based Care

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

With the goal of accountable care organizations and population health being patient centric, it is important that stakeholders involved in the care of the patient develop partnerships to deliver high-quality care in a cost-effective manner, explained René Lere, MD, president of Florida Blue and GuideWell.

There are 3 main risks to the sustainability of accountable care organizations and the move to accountable care, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

As the country increases the pace of shifting to value-based payments, a significant question remains: how can independent primary care doctors operate in this new environment?

Transitioning to a healthcare system based on accountable care presents many challenges, though the potential benefits may be well worth the effort.

This article examines the features a care coordinator should look for in care coordination tools to ensure they meet the needs of patients, the care team, and the care coordinator.

Gaps in ACO implementation readiness are identified as appointment reminders, referral follow-ups, care management, care transition alerts, clinical quality measure knowledge, and resources.

The American Journal of Managed Care and the Robert Wood Johnson Foundation will host a Tweetchat September 29 from 11 am to noon EDT on the Culture of Health and the impact of accountable care organizations (ACOs).

Focusing on quality and quality measurements has the potential to reduce costs, increase quality, and deliver more value to patients, consumers, and customers.

To provide guidance for successful partnerships, the authors identify common themes from their experience with successful health plan/medical group partnerships programs.

The characteristics of patients who visit practices that are ready versus unready for the patient-centered medical home differ in important ways.

As CMS pushes healthcare systems to move away from fee-for-service, the state's largest insurer makes a major move toward value-based payment.

There are a couple of health information technology challenges facing new accountable care organizations that are bringing together different entities with disparate systems that need to learn to work together, explained Scott Berkowitz, MD, MBA.

The first year to 18 months of an accountable care organization (ACO) is the most challenging as data begins to trickle in of everywhere a patient went to get care, and healthcare providers typically aren't taught how to utilize that information, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

The top managed care news this week included draft guidance to reign in the controversial 340B drug program and the top pharmacy benefit managers made it clear they are looking for price discounts for the PCSK9 inhibitors.

Leah Binder, president and CEO of The Leapfrog Group, will be the keynote speaker at the upcoming meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held October 15-16, 2015, in Palm Harbor, Florida. The Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across healthcare to share ideas for navigating the changing reimbursement landscape.

The results for 2014, which was Year 3 of the program, revealed winners and losers and showed that ACOs may not be the only solution to hold down the cost of healthcare.

As the United States progresses toward improving health and healthcare while lowering cost, the need for standardized, evidence-based measures becomes all the more important.

With various healthcare stakeholders having different wants and needs from the healthcare system, meetings that bring all parties together in one room are important, according to Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, and keynote speaker at the spring live meeting of the ACO and Emerging Healthcare Delivery Coalition.

Analysis of publicly reported organizational characteristics, shared savings distribution plans, and early financial success of accountable care organizations in the Medicare Shared Savings Program.

This editorial reviews the recently published study (AJMC April) by Gerrard et al, which analyzed the statistical prediction model of the Fitness Index Measure for hospital readmission in unilateral hip fractures.

A report from the Government Accountability Office has found that a program for hospitals serving poor and uninsured patients has created perverse incentives to prescribe more drugs and more expensive drugs, particularly in the area of cancer care.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

With various accountable care organization models that cover a wide range of health coverage plans, organizations with multiple models need to create a common framework for each market to follow in order to manage them.

The approach for assessing hospital penalties under the Hospital-Acquired Condition Reduction Program might need to be reconsidered in order to achieve the intended goal of the program.

Andrew Sussman, MD, president of MinuteClinic and senior vice president and associate chief medical officer of CVS Caremark, foresees a number of changes to come in terms of healthcare delivery in the US.

As clinical targets in more common malignancies emerge, testing and treatment options will increase. Balancing these choices with the high costs of new technology will be the challenge to ensure value in oncology care.

Picking the right measurements to assess improvement in medication management depends largely on the what group is being considered, said Woody Eisenberg, MD, senior vice president of performance measurement and strategic alliances for the Pharmacy Quality Alliance.

When Providence-Swedish Health Alliance signed with Boeing to create a unique employer-sponsored accountable care organization, figuring out the logistics of the model took some time, according to Joseph Gifford, MD, CEO of Providence-Swedish Health Alliance.

Leah Binder, MA, MGA, president and chief executive officer of The Leapfrog Group, encourages everyone to attend The American Journal of Managed Care's ACO and Emerging Healthcare Coalition Fall live meeting, which will be held October 15-16 in Palm Harbor, Florida.