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News Clips
Med City News (6/25) How More Competition and Better Connected Data Will Solve Healthcare’s Billion Dollar Problem – In most regions, employers and individuals only have a handful of health plans to choose from. Three, maybe four. The lack of meaningful competition limits quality and innovation and allows health plans to do the bare minimum. Looking ahead, we don’t need more companies offering “different” solutions for the sake of being different. We need more companies that do the same thing for the same populations. True competition creates motivation to develop higher-value services, more robust networks and more innovative payment models. Getting there will take more than articles. Health systems need to make interoperability a priority, not a side project. Insurers must deliver real transparency, not just check the compliance box. Employers should stop piling on point solutions and start demanding integrated platforms. And tech companies have to earn trust by delivering transparent value from day one.
Health Affairs (6/16) As Medicare Progress Stalls Nationally, Can States Advance Site-Neutral Payment Policies? – Congressional proposals to align Medicare payments for identical services of equal complexity, regardless of their delivery setting—referred to as site-neutral payment—have struggled to get enacted, despite bipartisan support. This hesitancy to act has implications that extend beyond losing the potential savings for Medicare and its beneficiaries. It also keeps commercial reimbursement higher than it would otherwise be, given the private market’s frequent hook to a Medicare fee schedule chassis. Rather than waiting for stalled Congressional efforts to enact so-far elusive Medicare policy changes, states could pursue site-neutral payment in their own health insurance markets. One state—New York—is considering such a proposal.
Fierce Healthcare (6/10) Op-ed: Physicians' promise to 'do no harm' threatened by unchecked commoditization, corporatization of US healthcare – Commoditization and corporatization of the U.S. economy may sound like complicated, theoretical jargon, but these trends have reshaped fundamental aspects of our daily lives. American consumers have accepted less competition and choice as small, personalized service shops and local businesses are replaced by Fortune 500 companies. We have adjusted to the mixed implications of this economic restructuring, sacrificing the friendly, personalized experience and customer service offered by local businesses for the “one-stop” shopping experience. For more than a decade, hospital chains, private equity-backed firms, health insurance companies and other corporate conglomerates have acquired physician practices at a breakneck speed. A perfect storm of market conditions and various government policies—including disparate Medicare payment structures and regulatory restrictions on physician ownership—that tilt the scales in favor of large, integrated entities has driven a flurry of acquisitions. Burdensome and expensive regulatory mandates further hinder the economic viability of small independent practices.
Health Affairs (6/10) Rescuing Value-Based Healthcare Through Better Data – Patients, clinicians and employers in the US have long been promised higher health care quality at lower cost, but costs per capita remain higher in the US than in any other established economy, without evidence of comparably higher quality of care. For the past two decades, much hope and effort have been put into value-based healthcare reforms and the creation of accountable care models. The premise was that payment and service delivery could both be optimized if high value was the common goal that unified stakeholders’ interests. That consensus might be dissolving as alternative approaches, often aimed at regulating prices directly, are implemented. While such legal force and regulation might cut spending, we reserve hope that optimizing value might still be achievable if the information content on which value-based reforms depend can be improved sufficiently. Achieving value-based care requires the capability to transmit all the determinative details of each patient’s health status and healthcare received, currently available in modern electronic health records (EHRs), to support modern data analytics. This Forefront article discusses how our current healthcare data extraction system prevents us from doing this and describes two pathways to achieve significant improvements.
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