News Clips
The American Journal of Managed Care: (8/2) – The unique circumstances safety-net providers face must be considered when designing and adopting alternative payment models (APMs). Prospective, population-based payments that are condition-specific or defined-scope-of-practice APMs account for the nonfinancial as well as financial risks that providers face and offer providers strong revenue stability and flexibility with lower risks.
JAMA: (7/28) – Consolidation of hospital systems and physician practices over the last decade has resulted in large health care systems where physicians face challenges to advocate and meaningfully participate in organizational governance. As a result, it is likely that there will be increased discussions of physician unions as a response to conflicts between physicians and hospital leaders over governance, compensation, work rules, and strategy.
Behavioral Health Business: (7/28) – In this interview, Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, discussed how CMS is addressing social determinants of health and equity in behavioral health care and the future of behavioral health services. Notably, she mentioned a goal of CMS is to make care more effective by providing payment for the integration of behavioral health with primary care, by investing in holistic care models like ACOs.
NEJM: (7/28) – This article highlights clinical and economic opportunities for primary care practices taking on accountability for total health care spending for a defined patient population, as well as several concerns. These concerns include providers intensifying their diagnostic coding and strategically investing in their performance on specific quality measures without meaningfully improving quality or efficiency. Further, providers may face a tough balancing act between economic incentives to demonstrate savings with the fiduciary obligations to generate profits for investors. The authors outline steps policymakers and primary care leaders can take to mitigate these concerns.
Medpage Today: (7/27) – This opinion piece contemplates the question of whether hospital consolidation is inherently bad for consumers, highlighting that evidence is mixed and analyses are hampered by the inability to account for a wide range of variables. The author concludes that he is optimistic large, consolidated, non-profit hospital systems will successfully meet quality and cost expectations
Health Affairs: (7/27) – This article outlines recommendations for states and the federal government to strengthen primary care. Among key approaches for state Medicaid programs is changing how primary care providers are paid to capitated or partially capitated primary care alternative payment models. The authors recommend that the federal government provide resources and reinstate federal funding for primary care practice improvement, especially for independent and rural practices, and revisit current approaches to Medicare payments for critical access hospitals and rural health clinics, which create misaligned incentives and preclude state participation in CMMI models.
Digital Health Insights: (7/27) – Key features of CMMI’s Enhancing Oncology Model have shown promise in previous programs and are strong candidates to carry over into future value-based care models, including refining incentive opportunities to support ongoing care transformation, focusing on a smaller number of eligible care episodes, and treating health equity as a central pillar of the patient experience.
Bain & Company: (7/27) - Bain & Company released a new study entitled “Primary Care 2030: Innovative Models Transform the Landscape,” which shows that new primary care models from nontraditional players could capture as much as a third of the US primary care market by 2030. Of note, the shift from fee-for-service to value-based reimbursement models has been one of the most significant sources of innovation in primary care, a trend that is expected to accelerate. Both independent and payer-owned advanced primary care providers will continue playing a major role.
American Action Forum: (7/26) - The Federal Trade Commission (FTC) has successfully fended off four major hospital mergers since the Biden Administration took office, and is looking to take further action in this space. Health care markets with the highest concentration have the highest prices - as much as 12 percent higher in markets with a single hospital vs. those of hospitals with four or more competitors. Hospitals have also been rapidly acquiring physician practices. The FTC has signaled it will take a closer look at vertical integration, cross-market consolidation, and consolidation’s effects on the labor market, among other issues.
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