News Clips
Annals of Internal Medicine: (6/28) – Over the past four decades, many efforts have sought to improve the delivery of primary care. Each practice improvement initiative has promise, and sometimes scientific evidence of efficacy, to improve care for the single disease or process targeted. Yet, implementation of initiatives requires time, training, possible practice redesign, and growing administrative burden. Initiatives also may require extensive patient education to manage or reframe expectations. These efforts may yield additional payment, but often the remuneration is not commensurate with the administrative burden required to claim it.
Healio News: (6/28) – Many physicians have looked at different organizational structures for joint ownership. Many independent groups have been faced with sale to local hospitals or health systems, leading to concern among physicians around loss of autonomy. The pandemic exacerbated this and, as a result, led to interest in other models. This article explores physician-management models as an alternative to private equity.
Newswire: (6/28) – The Health Care Transformation Task Force (HCTTF) announced the release of a new resource titled “Stories from the Field: Implementing Principles of Person-Centered Care.” The Implementation Guide provides best practices that exemplify the Task Force’s guiding patient-centered care principles. It also includes an operational “checklist” of steps and processes that successful health care organizations use to achieve their patient-centered care and health equity goals. The Implementation Guide serves as a companion resource to the Person-Centered Care as a Cornerstone of Value-Based Payment: Five Guiding Principles that the Task Force released in 2021.
Health Affairs: (6/27) – Diabetes process and outcome measures are common quality measures in payment reform models, including Alternative Payment Models (APMs) and value-based insurance design (VBID). VBID is a benefit design strategy that reduces patients’ out-of-pocket spending requirements for high-value care and sometimes increases out-of-pocket spending for low-value care. Unlike APMs, VBID models put the onus of incentivizing quality on payers rather than providers. This commentary reviews evidence from selected research to examine whether these payment models can improve the value of diabetes care.
Managed Healthcare Executive: (6/27) – Medicaid managed care organizations (MCOs) may be better equipped to address social determinants of health and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination. For providers to effectively deliver value-based care and proactively minimize health risks, they need to understand how SDOH are impacting their members. This article describes why SDOH are a critical factor for preventing member risk escalation in value-based care.
Health Leaders: (6/24) – The American College of Physicians (ACP) has proposed a seven-part set of reforms to link physician payment to value and equity rather than volume of services. Policymakers and lawmakers have been seeking to replace fee-for-service reimbursement in health care with value-based payment models since passage of the Patient Protection and Affordable Care Act in 2010. The position paper urges more meaningful efforts to create value-based payment models, noting that “policy leaders and the clinical community must work together to make progress toward equity using value-based payment.”
AJMC: (6/23) – Florida Cancer Specialists & Research Institute (FCS) was an early adopter of value-based care initiatives. For nearly a decade, its physician, pharmacy, and business leaders have been active participants in the Oncology Care Model (OCM), and equally active in policy discussions at the state and national levels about the future of payment reform. The holistic approach of FCS to value-based care goes back to the proverbial Triple Aim in health care: that is, improving patient experience, improving population health, and reducing cost. FCS is making sure that these factors of value-based care are working together in a balanced fashion.
AJMC: (6/23) – The Oncology Care Model (OCM) is set to end June 30, 2022. However, the end of the model does not mean the lessons of value-based care will cease. The challenge, many providers say, will be figuring out how to keep what worked in the OCM without the support of the model’s Monthly Enhanced Oncology Services (MEOS) payments, which helped practices afford navigation and nutrition services and social workers. The OCM has created “a good foundation” for commercial plans to build value-based models in oncology, and for regulators to pursue the next wave of reform in Medicare.
Benefits Pro: (6/22) – Over the past decade, value-based care and its corresponding contracts have become extremely popular in the managed care industry. These arrangements are a large and growing area of focus for a variety of health care stakeholders: networks, providers, governments, and employers. There are many examples of major payers adding more value-based care models - Optum, for example, has stated that value-based care is “vital for survival.” For the health care system to achieve greater value, we must work to understand, track, and manage care by the true definition of value: the price, efficiency, and quality of the care delivered from the service unit to the care pathway.
Doc Wire News: (6/22) – DocWire News spoke with Dr. Jonathan Slotkin, chief medical officer at Contigo Health (a Premier company), who spoke about the ongoing shift to value-based care, among other topics. In regards to value-based care, Dr. Slotkin stated that “COVID-19 has really underscored the transition to value-based payment models. The transition needs to be really meaningful and well beyond what we see now in value care, which is modest scale and pilot efforts.”
Health Affairs: (6/22) – The Altarum Research Consortium for Health Care Value Assessment is taking the next step to address gaps and advance better value across the health system by forming the “Broader Value Initiative”. The Broader Value Initiative’s first step will be to convene an “Expert Panel on Health Care Value”—a multi-stakeholder working group that brings together leading experts from a wide range of disciplines and stakeholder perspectives to recommend concrete steps to address barriers to understanding health care value across the system.
|