News Clips
WSHU: (7/11) – Private health care practices are finding financial and labor relief in large hospital systems. However, this leaves patients paying a higher cost for health care in a less personal setting. This article outlines more on what is contributing to consolidation and a decreased number of providers working in independently-owned practices.
Health Affairs: (7/11) – Recent debate around prior authorization in Medicare Advantage plans has focused on the process of prior authorization rather than which specific clinical services are actually subject to it. By deploying prior authorization in the right ways for the right purposes, Medicare Advantage can cement its role as a leader in value based care while protecting seniors and reducing costs for beneficiaries and the health care system alike.
AMA: (7/11) – Models for physician payment and compensation are notable for their variation and complexity. During a recent webinar held by the American Medical Association on issues in physician compensation, panelists noted that COVID-19 introduced more complexity in this space, but also introduced needed flexibility from both government and private payers leading toward more adoption of value-based concepts.
AJMC: (7/11) – This study outlined results from a survey conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient. Primary care providers were asked about their involvement in cancer care and value-based care, among other questions. Twenty-four (45.3 percent) reported value-based metrics as “somewhat” or “very” important when asked how important it would be to refer a patient to an oncologist who contracted with a health plan with a value-based payment model.
Health Payer Intelligence: (7/11) – According to a recent study published in Health Affairs, chronic disease management in diabetes may benefit slightly from value-based care and alternative payment models. The study examined whether alternative payment models (APMs) can improve the value of diabetes care, finding that higher-risk APMs yielded greater improvements in diabetes process measures than lower-risk APMs and that value-based insurance design (VBID) models appeared to improve medication adherence but not other quality measures.
The New England Journal of Medicine: (7/09) – The movement toward value-based payment has been a defining feature of U.S. health care reform during the past decade. Models like the ACO REACH model have been launched to address concerns about inequitable effects of value-based payment programs and to promote both value and equity as a central goal. This article outlines how several provisions of the ACO REACH model could help advance health equity and move the health care system toward a more progressive value-based payment approach.
Health Affairs: (7/08) – Primary care physicians stand at the front line of ensuring the highest possible level of physical and behavioral health for people throughout their lifetime, and aim to do this while navigating the challenges of limited time with patients and often inadequate resources. The authors of this article believe that primary care systems must urgently embrace a paradigm shift, accelerating the adoption of behavioral health integration in physician practices and addressing this increase in unmet needs.
JAMA Network: (7/08) – This study looked at whether the CMS Value-Based Purchasing (VBP) program is associated with changes in patient-reported experience in safety-net versus non-safety-net hospitals. The study found that safety-net hospitals had lower performance than non–safety-net hospitals across all measures of patient experience and satisfaction. Findings suggest that the VBP program implementation was not associated with improvement in measures of patient experience in safety-net vs. non–safety-net hospitals.
Health Affairs: (7/08) – In previous Health Affairs blogs, Drs. Don Berwick and Rick Gilfillan argue that MA plans receive higher premiums relative to what CMS would pay in traditional Medicare. One of their recommendations is to eliminate the disease-based risk-adjustment hierarchical condition category (HCC) risk scoring system. While these original posts addressed the role of risk adjustment in the MA system (the subject of this response), the subsequent debate has been more concerned with the MA business model and its effect on member quality and financial outcomes.
Medical Economics: (7/06) – Various regulations, initiatives, and platforms seek to unlock data from separate silos for free-flowing exchange that enhances the patient experience and enables data-driven improvements in health outcomes. Health plans and providers remain invested in using data to achieve improved care coordination while lowering costs. This article discusses five adoption habits that will guide the essential transition to value-based care for leveraging patient data.
|