News Clips
Annals of Internal Medicine: (6/21) – Socioeconomic factors remain one of the most clinically significant contributors to health outcomes in this country, yet the current fee-for-service payment structure incentivizes volume and does not address such factors. In this paper, the American College of Physicians proposes specific policy recommendations on reforming payment programs, including those designed to treat underserved patient populations, to better address value in health care and achieve greater equity. The proposal advocates that population-based prospective payment models, including hybrid models that combine fee-for-service with prospective payments, not only have the potential to achieve high-value care but can also be designed in such a way as to adjust for the social drivers that impact health outcomes.
Healthcare Finance: (6/21) – In this episode of HIMSS TV, Castell's chief analytics officer Andrew Sorenson discusses the wider applications of value based care for providers and how health systems can surpass the obvious options for value based care.
Medical Economics: (6/20) – Transitioning to value-based care in health care is long overdue. Value-based care models place outcomes at the center and make care more equitable for all. Considering that only 10-20 percent of a patient's health outcomes are impacted by the health care system directly, a value-based care model requires providers to understand and optimize the other factors affecting a patient's health. Personalizing patient care based on each patient’s social determinants of health is no longer a nice-to-have – it’s a must.
Managed Healthcare Executive: (6/17) – Since its inception in 2012-2013, the CMS Medicare Shared Savings Program (MSSP) started with 220 participating accountable care organizations (ACOs) and 3.2 million beneficiaries, and reached its high point in 2018 with 561 organizations covering 10.5 million people. That was the same year that CMS unveiled Pathways to Success and the number of participating ACOs fell to 487. “We definitely think that Pathways has had an effect on the overall interest in the program,” says Jennifer Gasperini, director of regulatory and quality affairs for the National Association of ACOs (NAACOS). “Pathways decreased the incentive to participate by doing two things: reducing the shared savings that you can keep if you are successful and pushing (ACOs) to risk more quickly.”
Forbes: (6/17) – CMS has seven value-based programs linking quality to payments, partly a result of the Affordable Care Act. It also has designed what are known as Accountable Care Organizations, or ACOs, to deliver top notch care at the lowest cost. "We in Medicare are looking to increase our footprint in value-based care and in holistic-care models where you're really encouraging that team-based approach to care," Dr. Meena Seshamani, Director of the Center for Medicare, recently said.
Milbank Memorial Fund: (6/16) – In Colorado, a group of health plans formed and self-funded the Multi-Payer Collaborative (MPC) in 2012, focused on transforming primary care and reforming health care payment in their state. With support from the Center for Evidence-based Policy, the MPC developed this Framework for Integration of Whole-Person Care. The Framework provides a roadmap for primary care practices as they seek to provide advanced levels of care, including the integration of behavioral and social health, and it prepares them to receive more advanced models of payment. The Framework also provides guidance for payer organizations migrating toward advanced payment models that pay for value delivered through integrated, comprehensive, whole-person, population-based approaches.
Fierce Healthcare: (6/15) – The American Hospital Association (AHA) penned a letter to Congressional leaders pleading for Medicare sequester cuts slated to take effect July 1 to be halted in light of the financial strain many of the nation’s hospitals are expected to face throughout 2022. Congress had initially paused the two percent payment cut as part of the CARES Act when the COVID-19 pandemic began to threaten providers’ bottom lines. Sequestration cuts were continually punted until last December, when a bill was signed to resume a one percent cut in April and the full two percent in July.
The Commonwealth Fund: (6/15) – In several commentaries over the past six months, leaders from CMS and the Center for Medicare and Medicaid Innovation (CMMI) have announced advancing health equity as a top priority. This emphasis is a result of CMMI’s review of the first 10 years of the Innovation Center, which showed that equity was not a priority in model design, participant recruitment, or evaluation. In its review of the past decade of evidence on these experiments, The Commonwealth Fund identified five areas in which CMS can focus efforts to advance health equity through payment and delivery system reform. Historically, CMS and CMMI have not systematically evaluated payment and delivery system reform models’ impact on health equity (e.g., reported quality or outcomes by race/ethnicity, geography, or social needs). CMS and CMMI can ensure this analysis is included in evaluations going forward.
Cascadia Daily News: (6/15) – The Affordable Care Act created CMMI to test ways to better deliver Medicare services and encourage healthy lifestyles for seniors. One of these CMMI models — the Global and Professional Direct Contracting Model — contracts with private companies, or Direct Contracting Entities (DCEs), to manage care for seniors enrolled in traditional Medicare within their provider networks. CMS announced the DCE model will transition to the new Accountable Care Organization (ACO) Realizing Equity, Access and Community Health (REACH) model at the beginning of 2023. The ACO REACH model makes critical changes to increase transparency, refocus on health equity and limit the ability to raise health care costs.
Healthcare Innovation: (6/14) – A new study in the Journal of Medical Internet Research has shown significant results on to what extent carefully targeted care management programs for Medicare beneficiaries can bring down costs for those attributed to ACOs - but only with the highest-acuity patients. The fundamental question asked in the study is: could creating specific “benefit” or “impactability” scores for individual patients, using a method known as “impactability modeling,” make a difference in terms of ensuring the optimal level of care management, and the best outcomes? And would prospectively implementing the score, and evaluating the results in a new case management program, help care managers determine how well patients might respond to such carefully directed care management efforts?
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