Axios: First look: New accountable care advocacy group (5/10) – Accountable for Health (A4H) is launching Wednesday with a mission to speed the transition from fee-for-service (FFS) payment to models that improve health outcomes and experiences. A4H will focus on advocacy, education and research about accountable care policy across payers. The group’s priority is improving understanding among lawmakers and other stakeholders about accountable care, Mara McDermott, the group’s founding CEO, said. The council will also work toward policy recommendations. A4H is starting to think about the future of MACRA, transforming care delivery for Medicaid and other policy recommendations.
Health Affairs: Nine Health Care Megatrends, Part 1: System And Payment Reform (5/9) – CMS has pledged to have all FFS Medicare patients in some kind of APM or ACO by 2030. Leading payers are implementing more APMs, especially prospective payments and capitation. Finally, APMs are taking hold not just for primary care providers but also for specialists. Bundles for orthopedic and other surgical procedures and value-based payments related to renal and oncology care are proliferating. And now cardiology groups are organizing to manage patients with serious cardiac conditions and receive risk-based payments. The trend toward implementation of APMs seems unstoppable. To be successful, the incentives will need to be well designed, infrastructure better developed, and performance information readily available. In the decade since the ACA, we have learned a lot about what does not work, enough to design and deploy reasonably effective—if not optimal—APMs.
STAT: Geisinger board member: Local consolidation influenced Kaiser-Geisinger deal (5/8) – A long-running flurry of hospital and medical group acquisitions in Pennsylvania forced Geisinger to make a bigger move of its own and to sell to Kaiser Permanente. That’s according to Gail Wilensky, who has been on the board of Geisinger since 2010. “There was no question there’s been a lot of consolidation going on in central Pennsylvania,” Wilensky said. “What’s been going on in Pennsylvania is not any different from what’s been going on in many places around the country. It was more that Geisinger was not in the best position to face the forces of consolidation going on around them and to feel that it would be able to continue doing the kind of work that it has done.”
Medical Economics: How data can save value-based care (5/8) – As value-based care models mature, measurements have expanded to include the social determinants of health and other issues that providers and payers must consider if they are to treat patients holistically. This includes the availability of transportation, family assistive services, affordable housing and other factors that provide a foundation for population health. This progress is encouraging, but the industry still has a long way to go. Clinical and financial metrics are just one lens to assess the success in delivering value-based care, and even medical, demographic and economic data is insufficient. More granular, incisive data on the health care industry itself is required to fully assess how much progress the industry is making in delivering value-based care.
Health Affairs: CMS’s Universal Foundation Measures Are Not Universally Good For Primary Care (5/8) – While there is broad support for the conceptual goal of the CMS effort—to reduce the incredible burden of measurement by aligning a core set of measures across payers—the question is: How would the fragile platform of primary care fare if CMS’s measures list were to become final? The short answer is: not well. These measures fall largely on primary care to collect and improve, and do not align with the high-value functions of primary care. Some of the measures proposed in the Universal Foundation could make strong contributions to an overall set created to serve the laudable aspirations of this program. However, the current proposed measures are both menial and lackluster. While the Universal Foundation may reduce burden for the health system generally, it loads nearly all the burden on primary care, a workforce already buckling from historic and systemic lack of support.
Medical Economics: Area Deprivation Index informs policy but misses mark at provider level (5/8) – Area Deprivation Index (ADI) can be used to better understand the markets and patient populations at the organization, provider, and patient levels. One of the goals for CMS regarding health equity is to encourage ACOs to take on more vulnerable populations. Pairing ADI with a proper health barrier and intervention tool will allow risk-bearing organizations to better strategize how to provide for these more vulnerable communities. In addition, doing so offers a more significant opportunity to hit quality and benchmark metrics and improve their impact revenue. ADI gives providers a piece of the puzzle for understanding the risk level of their patients. However, the ADI alone cannot connect the dots in terms of what health barriers a given patient faces. Trends demonstrate the higher the deprivation, the greater the average annual cost to support those patients. However, not all high ADI values indicate high health barriers, and not all lower scores mean lower health barriers.
New York Times: Corporate Giants Buy Up Primary Care Practices at Rapid Pace (5/8) – The absorption of doctor practices is part of a vast, accelerating consolidation of medical care, leaving patients in the hands of a shrinking number of giant companies or hospital groups. Many already were the patients’ insurers and controlled the distribution of medicines through ownership of drugstore chains or pharmacy benefit managers. But now, nearly seven in 10 of all doctors are either employed by a hospital or a corporation, according to a recent analysis from the Physicians Advocacy Institute. Some experts warn the consolidation will lead to higher prices and systems driven by the quest for profits, not patients’ welfare. This consolidation of medical care may also run afoul of state laws that prohibit what is called corporate medicine. Such statutes prevent a company that employs doctors from interfering with patient treatment.
Modern Healthcare: FTC's noncompete ban could apply to nonprofits, former staffers say (5/8) – While the legislation that created the Federal Trade Commission (FTC) may shield nonprofit entities from the agency’s oversight, some former FTC staffers say the commission could invoke other laws to prevent individual nonprofit hospitals from using noncompete provisions in employment contracts. The FTC Act, which created the agency and outlined its purview in 1914, defines a corporation as a company that “is organized to carry on business for its own profit or that of its members.” Some health care lawyers said the act definitively exempts nonprofits from the FTC’s oversight, while others said the scope of the exclusion is unclear. It’s unlikely the FTC would make a sweeping rule with a loophole that 60 percent of hospitals could fit through, said Barak Richman, a law and business professor at Duke University. “Where there is a policy will, there is a legal way,” Richman said.
Health Affairs: The Health Plan Price Transparency Data Files Are a Mess - States Can Help Make Them Better (5/5) – The promise of price transparency prompted the federal government to require insurance companies to publicly post the prices they pay for all health care services. These new requirements, along with other data sources, have the potential to be powerful resources that support state-level efforts to improve insurance affordability. But this potential may be largely unrealized without a state-federal partnership to improve data access and quality. Multiple states have embarked on efforts to constrain health care cost growth and improve the affordability of coverage for local employers and residents. Many of these efforts could benefit from access to more robust, real-time, and provider-specific information about the prices that insurers are paying. For example, price data could be used to support anti-trust enforcement. Price data can provide an independent source of information for state attorneys general and others monitoring compliance with anti-trust settlements and prohibitions on anti-competitive contracting practices.
Med City News: As Workforce Shortages Intensify, CMS’ Value-based Care Ambitions Hang in the Balance (5/5) – Value-based care could forever transform the way health care is delivered and experienced in rural communities, unshackling rural clinicians from the fee schedule and giving them the freedom to provide the level of care people living in rural communities deserve. It is, however, dependent on rural providers’ ability to close gaps in access, improve quality and ensure patient satisfaction. Absent the ability to bolster their ranks with more clinicians, what health centers need first and foremost to shift to value are technologies that amplify their clinical capacity without further burdening and burning out their core staff. For value-based care to succeed, clinicians need tech-enabled services that extend their reach, that provide a whole-person view of their patients when they are not directly in front of them, and empower them to proactively manage their patient population.