Value-Based Care

Barry Russo, CEO of The Center for Cancer & Blood Disorders, said that his practice continues to collect quality and claims data from a number of sources, even though it isn’t easy. Russo also said that payers are not particularly interested in participating in a value framework, instead choosing to focus on the oncology care model (OCM).

Though there are many unknowns regarding how the Trump administration will affect policy, there is bipartisan support for lowering costs and increasing quality. The Medicare Access & CHIP Reauthorization Act of 2015 is a separate law that was passed with 92% bi-partisan support in 2015. Read on for tips on creating a strategy that will set you up for success under advanced alternate payment models.

In Hennepin County, Minnesota, which has one-fifth of the state’s population, the government has worked with the healthcare system to create a different way to care for people.

Innovative funding models like value-based payments can change providers’ incentives and drive them to seek solutions like palliative care, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

Relationships with accountable care organizations and provider organizations can help payers join in a value-based, holistic approach to improving health within a community, said Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

Bundled payments are an interesting experiment, but they should have more clinically relevant time periods and include more quality measures, said Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

The group that represents 5000 hospitals outlined a policy agenda that calls for regulatory reform but also seeks some certainty that patients who gained coverage under the Affordable Care Act will be able to retain it in the future.

Access to dermatology care is limited around the world, especially in remote areas, but the Veterans Affairs' teledermatology program aims to improve both access to and quality of dermatological care, said Nellie Konnikov, MD, professor and chief of dermatology at the Boston Department of Veterans Affairs.

Patients who received care for their chronic diseases in a patient-centered medical home had higher rates of medication adherence over 12 months than patients treated elsewhere, according to a study in the Annals of Internal Medicine.

Accountable care organizations are seeking to expand population health management capabilities through relationships with community organizations and patients, according to a new report.

Accountable care organizations all over the country have shown that no single method can work for every system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation.

As the healthcare industry moves toward value-based care and accountable care organizations and other new financial models gain greater importance, Aledade is looking to guide physicians to success.

After CMS released its proposed rule for the Medicare Access and CHIP Reauthorization Act, it received overwhelming feedback from clinicians that spurred the agency to make a number of changes for the final rule, according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Hospital consolidation is a common practice, but its benefits can often be accomplished through other mechanisms, said Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

CMS has a number of mechanisms in place to help physicians successfully adapt to the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA), according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. These efforts include funding practice transformation and quality improvement networks as well as building partnerships with medical societies.

As the healthcare industry continues its transition towards alternative payment models (APMs), some providers might feel apprehensive about keeping up with new requirements like those in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. However, these providers can use healthcare information technology (IT), data analysis tools, and other resources to adapt to these changes, according to Suzanne Travis, vice president of regulatory strategy at McKesson.

In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.

At the fall live meeting of the ACO & Emerging Healthcare Delivery Coalition in Philadelphia, Pennsylvania, attendees heard presentations and participated in workshops that discussed care management, value-driven payment systems, and the future of healthcare.

When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations.

The opportunities for telehealth to radically transform the healthcare system are enormous, but the foremost priority of these innovations must be the delivery of value, said Reed V. Tuckson, MD, FACP, at the National Committee for Quality Assurance Quality Talks conference in Washington, DC, on Monday.

Employers face tough decisions about rising costs, high-quality care, coordination of benefits, and workplace accommodations when employees are diagnosed with cancer, but they will always want to support those employees as best they can, according to Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health.

The healthcare community needs to understand and address the personal and social circumstances that contribute to a patient’s health before they can improve the quality of care, according to 2 presentations in the first segment of the National Committee for Quality Assurance Quality Talks conference in Washington, DC.

One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

The number of accountable care organizations (ACOs) has grown rapidly over the last 4 years, with more than 800 ACOs now covering an estimated 28 million Americans. A study found that commercial ACOs were significantly larger and more integrated with hospitals and had lower benchmark expenditures and high quality scores compared with noncommercial ACOs.

Despite progress, tying healthcare payments to value has proved easier in theory than in practice, according to speakers at this fall’s meeting of the ACO & Emerging Healthcare Delivery Coalition. Experts convened October 20-21, 2016, by The American Journal of Managed Care looked ahead at the challenges the next president will face with the future of the Affordable Care Act.

Accountable care organizations (ACOs) have been laying the groundwork for the requirements for the Medicare Access and CHIP Reauthorization Act (MACRA), which will give physicians participating in ACOs an advantage during the implementation of the new Medicare payment system, said Katherine Schneider, MD, president of the Delaware Valley ACO.

The innovative strategy of hotspotting, implemented by the Camden Coalition of Healthcare Providers, was the focus of a session and a panel discussion during the first day of the ACO & Emerging Healthcare Delivery Coalition.

Panel members discuss the level of physician awareness regarding changes that will follow the implementation of CMS’ recently released Medicare Access and CHIP Reauthorization Act (MACRA).

In the keynote speech at the ACO & Emerging Healthcare Delivery Coalition, Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy, started out by providing a broad picture of Medicare reform before narrowing it down to what is happening on the ground.

Healthcare attorney James M. Daniel, Jr, JD, MBA, explained how healthcare providers will be impacted by CMS’ newly released final rule on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) in a session during the second day of the ACO & Emerging Healthcare Delivery Coalition.