Fierce Healthcare: (6/15) - At a meeting this week, the American Medical Association’s (AMA's) delegates adopted new policies specifically targeting peer-to-peer (P2P) review of prior authorization decisions and the particular burden of prior authorization during a public health emergency. The new AMA policies adopted call for P2P prior authorizations to be made actionable within 24 hours of the discussion; the reviewers to follow evidence-based guidelines consistent with national medical society guidelines where available and applicable; and the temporary suspension of all prior authorization requirements and the extension of existing approvals during a declared public health emergency.
Axios: (6/14) - Some of the hospitals with the highest revenue in the country also have some of the highest prices, charging an average of 10 times more than the actual cost of the care they deliver, according to new research by Johns Hopkins University. Of the top 100 largest hospitals in the U.S., 57 were charging more than five times the actual cost, on average, of the care they provided. Nine hospitals were charging more than 10 times the actual cost. The hospital with the highest average markup was HCA's Chippenham Hospital in Richmond, with charges at nearly 13 times its cost.
Inside Health Policy: (6/14) - Center for Medicare and Medicaid Innovation Director Liz Fowler told stakeholders there needs to be uniformity across payers -- including CMS -- in how to gauge their health equity efforts and make them successful. Clear guidance from CMS on health equity could also help states tackle the issue, Duke Margolis Center for Health Policy suggests in a recent analysis. Fowler said CMMI hopes to use the Health Care Payment Learning and Action Network to help ignite a national sense of urgency behind tackling health equity. Duke’s paper also notes that the LAN is planning to support pilot efforts to accelerate multi-payer alignment, “particularly around advanced primary care and addressing health equity.”
Beckers Hospital Review: (6/11) - The U.S. could face a shortage of between 54,100 and 139,000 physicians, including a potential shortage of 21,400 and 55,200 primary care physicians by 2033, according to new data from the Association of American Medical Colleges (AAMC). The estimate is higher than AAMC's 2019 report, which projected a shortage of up to 121,900 physicians by 2032.The Life Science division of IHS Markit, a global information company, conducted the study for AAMC before the COVID-19 pandemic. While the analysis excludes specific information or scenarios based on that crisis, it does include supply and demand scenarios and was updated with the latest information on health care trends, such as data on physician work hours and retirement trends. AAMC cites population growth and aging as the primary drivers of the projected physician shortage from 2018 to 2033.
Fierce Healthcare: (6/11) - Many physicians increased their net worth over the last year of quarantine despite reporting relatively steady incomes and COVID-19-related practice issues, according to new survey data. Among nearly 18,000 physician respondents polled by Medscape, the proportion of those reporting a net worth greater than $1 million increased from 50% the previous year to 56% in 2020. Twenty-eight percent said they had a net worth lower than $500,000, while 10% valued themselves greater than $5 million.
HIT Consultant: (6/11) - Value-based payment doesn’t have to be a zero-sum game: Providers can achieve healthy margins while payers decrease risk and associated costs. The key to realizing value is to partner closely with payers to develop models that support data sharing, high-quality care, and reduced waste, which is critical given that $600 billion in health care spending could be considered waste. To succeed under value-based models, providers must intensify their focus on delivering the right care to the right individual at the right time. This means zeroing in on the populations most at risk of adverse outcomes and readmissions. Success also requires providers to reexamine practice patterns that do not provide value, such as the use of higher-cost settings of care for laboratory orders or imaging tests, or variations from evidence-based practices of care. In the move toward a value-based environment, providers who are willing to adjust higher-cost behaviors will be more likely to succeed under new payment models.
National Law Review: (6/11) - Impediments to value-based behavioral health care include difficulty in identifying standardized treatment models for chronic behavioral health conditions, data gaps and provider reluctance to take on financial risk associated with behavioral health conditions. While a disconnect between medical and behavioral health care is not a new phenomenon, the authors see the uptick in payor audits and recoupment claims against behavioral health providers as an indication that the fee-for-service model is ripe for evolution towards value-based care. Value-based care, while complex to apply to behavioral health, could help payors achieve the cost savings and predictability they are demanding, while giving providers and patients more flexibility in treating chronic behavioral health conditions.
RevCycle Intelligence: (6/11)- The National Institutes of Health (NIH) awarded a $3 million grant to Sarah Goff, MD, PhD, a health services researcher at the University of Massachusetts Amherst, to study the effects of accountable care organizations (ACOs) on childhood asthma care, according to a recent announcement.About 6 million children aged zero to 17 have asthma in the US, according to the Centers for Disease Control and Prevention (CDC). Asthma can be managed with medication, but CDC data shows that almost half of children with prescribed asthma medications do not regularly use them. Throughout the five-year study, Goff will analyze data from 17 Massachusetts Medicaid ACOs launched in 2018, looking at health outcomes for Medicaid-insured children with asthma compared to children with commercial insurance and Medicaid-insured children with non-ACO plans.
Health Payer Intelligence: (6/11) At the beginning of 2021 as much of the country remained unvaccinated, payers stalled their value-based contract negotiations, according to an Insights report. Participation in the most common alternative payment model—the pay-for-performance model—dropped by 18 percent in 2020, meaning that less than half of the survey respondents were in this payment model. Payers and their provider partners invested their energies in increasing coronavirus testing and pushing the coronavirus vaccine out to eligible members. Although value-based contracting did suffer a stalled start in 2021, a handful of payers have moved forward with value-based contracts in the first half of the year. This article provides a summary of four payers Blue Cross Blue Shield of North Carolina, Humana, Blue Cross Blue Shield of Minnesota and MVP Health Care And The University Of Vermont Health Network who have adopted value based care.
LAN: (6/10) The Health Care Payment Learning & Action Network (LAN) convened a Health Equity Advisory Team (HEAT). As a public-private partnership, the LAN recognizes that alternative payment model (APM) design and implementation must intentionally address factors that drive health inequities. The LAN established the HEAT to help identify and prioritize opportunities to advance health equity through APMs, to influence design principles and to inform LAN priorities and initiatives. Its goal is person-centered—leverage APMs to help make needed care more accessible, drive better patient outcomes, and reduce disparities.
Health Affairs: (6/10) - Health Affairs released a two-part article on the lessons learned about value based care over the past ten years and future policy recommendations for CMS and CMMI. The years of reform experience, recent trends, plus a new Administration that has expressed a commitment to effective payment reform have led to a number of thoughtful assessments of how to proceed from here. The post reflects on “lessons learned” from the evidence gained from the past decade and beyond to promote the effectiveness of Alternative Payment Models (APMs) and describes the implications for future Value Based Payment (VBP) efforts and the implications for CMS and CMMI. Part one of this post discussed lessons concerning the development and implementation of VBP models. Part two of this post discussed lessons regarding the refinement and expansion of VBP models, which are crucial to achieving system-wide transformation. Part two also summarizes key themes of the past decade of payment reform experience and emphasizes the importance of building off these lessons.
Health Affairs (6/7) - Although much attention has been focused on individual-level drivers of burnout in primary care settings, examining the structural and cultural factors of practice environments with no burnout could identify solutions. In this cross-sectional analysis of survey data from 715 small-to-medium-size primary care practices in the United States participating in the Agency for Healthcare Research and Quality’s EvidenceNOW initiative, the authors found that zero-burnout practices had higher levels of psychological safety and adaptive reserve, a measure of practice capacity for learning and development. Compared with high-burnout practices, zero-burnout practices also reported using more quality improvement strategies, more commonly were solo and clinician owned, and less commonly had participated in accountable care organizations or other demonstration projects. Efforts to prevent burnout in primary care may benefit from focusing on enhancing organization and practice culture, including promoting leadership development and fostering practice agency.