Value-Based Care

An integrated primary care service may improve the health status of patients with severe chronic obstructive pulmonary disease (COPD) without increasing health care costs, according to a recent study.

At AHIP 2022, Vanessa Bobb, MD, PhD, FAPA, vice president of Behavioral Health & Medical Integration at CDPHP, moderated a session on real-world study findings showcasing cost and quality benefits of value-based contracting in behavioral health. Bobb discusses findings of the study and how value-based programs can be better leveraged in mental health and substance abuse care.

Integrating primary care with behavioral health services, improving provider training on mental health, and policy changes were all noted as strategies to combat the rising mental health and substance abuse epidemic during a keynote session at AHIP 2022.

In the second of 2 parts, Nathan H. Walcker, MBA, CEO of Florida Cancer Specialists & Research Institute (FCS), discusses what he’d like value-based care to look like going forward. CMS ended the Oncology Care Model (OCM) yesterday after 6 years and has invited practices to apply for a successor model, the Enhancing Oncology Model.

In the first of 2 parts, Nathan H. Walcker, MBA, CEO of Florida Cancer Specialists & Research Institute (FCS), discusses the future of value-based care for the practice as the Oncology Care Model comes to an end today. This week, CMS announced it will launch a successor model.

The utility of value-based frameworks for payers, providers, and those involved in kidney care delivery was addressed during a session at AHIP 2022.

Designing rational spending targets and having small sample sizes are 2 main challenges payers and partners face in the shift toward alternative payment models (APMs), said Ravi B. Parikh, MD, MPP, assistant professor of medical ethics and health policy, assistant professor of medicine, University of Pennsylvania.

Ashok Subramanian, MBA, founder and chief executive officer, Centivo, speaks on the limitations of traditional employer-based health benefit plans in the pursuit of value-based care and what employers should consider in designing these incentives on a community level.

The authors call for the collection and use of data on virtual health care to shape an informed and thoughtful approach to telehealth payment that equitably serves all stakeholders.

Thirst outcomes were investigated among patients with stable heart failure (HF), due to the limited data available on this relationship and how it, along with fluid and sodium intake, influences clinical outcomes in this population.

The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural Americans are available, and CMS can help us utilize them.

As we reset post pandemic, providers and payers are in an excellent position to prioritize a reallocation of health care expenditures driven primarily by individual and population health gains.

Neil Goldfarb, president and chief executive officer of Greater Philadelphia Business Coalition on Health (GPBCH), provides an overview of the core discussion points and other aspects in-person attendees can look forward to at the 2022 GPBCH Annual Conference.

Today, health plans are shifting dollars to more value-based contracts along with investments in population health management. Digitizing lab results across all care settings and unlocking the potential of lab values can help health plans reach the Triple Aim of improving the patient experience, improving the health of populations, and reducing the per-member cost of health care.

This study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.

Trends in surveillance testing after treatment for colorectal cancer remained relatively stable recently, and patients who overutilized surveillance measures had quicker recurrence detection but higher costs.

Marking Mental Health Awareness month, stakeholders involved in the delivery of behavioral health care services discuss current efforts underway—spearheaded by the novel 988 emergency hotline—to address the growing mental health crisis.

UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.

An editorial in response to the editor in chief’s December 2021 letter discusses evidence supporting the cost-effectiveness of an innovative advance care planning initiative.

To achieve health equity, experts from CVS Health discuss why we must invest in programs that improve access to health care for historically marginalized communities, address social determinants, boost health education, increase representation in all levels of health care delivery, widen access to clinical trial research, and more.

Nathan H. Walcker, MBA, chief executive officer, Florida Cancer Specialists & Research Institute (FCSRI), discusses what guests can expect at the in-person Tampa meeting of The American Journal of Managed Care®'s Institute for Value-Based Medicine® (IVBM), co-hosted by FCSRI.

Michael Diaz, MD, president and managing physician, Florida Cancer Specialists & Research Institute, previews the Tampa meeting of The American Journal of Managed Care®'s Institute for Value-Based Medicine® (IVBM), cohosted by Florida Cancer Specialists & Research Institute.

Use of low-value care services during COVID-19 exhibits substantial heterogeneity but, on average, shows declines similar to the use of high-value services; low-value care use lags behind high-value care use in the rebound phase.

Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, talks about lessons learned from the Oncology Care Model (OCM) and Medicare that are being used to innovate toward value-based care.

Reducing low-value care means saving money, reducing potential harm, and creating room for high-value care to be delivered in the United States.

Panelists touted the ability to pay for items and repairs to keep Medicare beneficiaries healthier at home, avoiding potentially costly hospitalizations and complications.

Without addressing rising costs, the problem of underinsurance in health care coverage will remain, said panelists at the 2022 V-BID Summit, discussing some of the smaller steps that are being proposed or are already in place to try to ease the financial burden.

At the 2022 V-BID Summit, hosted by the Center for Value-Based Insurance Design at the University of Michigan, representatives of CMS and the Commonwealth Fund gave an update on the efforts to monitor, evaluate, and improve health equity in the United States.

Dennis P. Scanlon, PhD, professor of health policy and administration at Pennsylvania State University and editor-in-chief of The American Journal of Accountable Care®, talks about major systemic and fundamental barriers to health systems becoming learning health systems.

Patients who cardiologists see once every few months are getting handed over to pharmacists who can monitor them more frequently and get them to their goals, said Crystal Zhou, PharmD, assistant professor of Clinical Pharmacy at the University of California, San Francisco (UCSF).