News Clips
Health Affairs: Bridging The Home-Based Primary Care Gap In Rural Areas (2/6) – Accountable care payment models can support rural home-based primary care (HBPC) providers by allowing flexible delivery of medical and non-medical care based on patient needs. Many HBPC providers are small and independent practices and do not have access to the capital needed to engage in accountable care models. In other models, CMS has started addressing this by providing upfront funding for infrastructure investments. For instance, MSSP will soon provide advanced incentive payments for smaller, inexperienced organizations. Through upfront capital, organizations can increase staffing, develop supportive infrastructure, and address non-medical drivers of health for their beneficiaries. CMS should consider providing similar infrastructure investment opportunities across its models to diversify participation.
Medical Economics: Shift to value-based care brings new desires for EHR capabilities (2/6) – The transition to value-based care will require changes in the electronic health record (EHR) systems physicians are using. Meanwhile, documenting clinical quality and sharing data are two needs driving intentions to upgrade technology in health care practices over the next 18 months. But EHRs are not keeping up: 82 percent of physicians said their EHR systems do not have technology to prepare their practices to be evaluated based on factors such as patient satisfaction, clinical outcomes, adherence to evidence-based practices, and overall cost-effectiveness.
Milliman: CMS Making Care Primary Model: Should I participate? (2/6) – On June 8, 2023, CMS announced the Making Care Primary (MCP) Model, a new voluntary 10½-year value-based care innovation model that seeks to make advanced primary care available and sustainable by creating a pathway for eligible primary care providers to transition from fee-for-service (FFS) to a prospective, population-based payment. Nonbinding applications for the MCP Model were due to CMS on December 14, 2023. Selected applicants who choose to participate in MCP will be required to sign a participation agreement with CMS before beginning participation on July 1, 2024.
Behavioral Health Business: CMS’ New Behavioral Health Model Illustrates Ongoing Effort To Push Value-Based Care, Integration Forward (2/5) – The Innovation in Behavioral Health (IBH) Model propels the industry towards value-based care and further integration with the rest of the health care system. The new model is an effort by the CMS to marshal public resources into a coordinated whole for those with severe behavioral health issues. Specifically, the model will connect adults with mental health conditions or substance use disorders (SUDs) to physical, behavioral and social supports, prioritizing a collaborative care model between behavioral health and physical health providers.
Health Affairs: Primary Care–Based Housing Program Reduced Outpatient Visits; Patients Reported Mental And Physical Health Benefits (2/6) – Screening for housing instability has increased as health systems move toward value-based care, but evidence on how health care–based housing interventions affect patient outcomes comes mostly from interventions that address homelessness. Patients enrolled in the program between October 2018 and March 2021 had 2.5 fewer primary care visits and 3.6 fewer outpatient visits per year compared with those who were not enrolled, including fewer social work, behavioral health, psychiatry, and urgent care visits. Patients in the program who obtained new housing reported mental and physical health benefits, and some expressed having stronger connections to their health care providers. Many patients attributed improvements in mental health to compassionate support provided by the program’s housing advocates.
JAMA: Transforming Value-Based Dementia Care—Implications for the GUIDE Model (2/5) – Dementia disproportionately affects older adults and represents an increasingly difficult population health and financial challenge for Medicare. Annual spending for Medicare beneficiaries with dementia is approximately three times higher than that for patients without dementia, with excess costs attributable to substantial fragmentation across the care journey. Patients with dementia experience polypharmacy and frequent hospitalizations and require careful coordination across multiple specialty health care professionals with support from unpaid caregivers. However, traditional fee-for-service (FFS) payment models may not adequately support costly medical and social needs for patients with dementia and their unpaid caregivers.
RevCycle Intelligence: Overcoming the Barriers to Value-Based Payment in Primary Care (2/5) – Primary care is arguably the most critical component of our health care system. Primary care and preventive medicine can help avert and manage chronic diseases and prevent long-term complications. However, efforts to improve primary care delivery, such as value-based payment models, are lacking. That’s not to say that the industry doesn’t understand the importance of value-based care when it comes to primary care, though. Prioritizing primary care can not only help improve patients’ overall well-being, but it can also redirect spending away from expensive specialty care that can be avoided when preventive visits are a regular occurrence. When these preventive visits are delivered under a value-based payment model, patients are more likely to experience quality care at lower costs.
Medical Economics: Introducing AIMPA: Primary care physicians are welcome (2/2) – The new American Independent Medical Practice Association (AIMPA) formed to be an advocacy organization for doctors in business on their own. That includes primary care physicians who want to remain independent – even as primary care has been hit the hardest by hospital consolidation and corporate employers gobbling up medical groups, said Inaugural President and Board Chair Paul Berggreen, MD.
Roll Call: ‘Site-neutral’ hospital policy muddles health package progress (1/31) – Legislative language to restrict hospital billing rates in outpatient clinics continues to divide lawmakers as they try to coalesce around a broader health care package, with concerns about rural hospitals stalling progress in the Senate. The language is aimed at preventing hospitals from buying up independent physician practices and then billing for the same services at a higher rate. Critics allege the practice unnecessarily increases costs, while hospitals argue their own costs are higher. Some so-called “site-neutral” policies are included in every major piece of health care legislation moving through the committees of jurisdiction, with the exception of legislation from the Senate Finance Committee. Senate Finance Committee Chair Wyden (D-OR) said he’s still working to understand how the policy would impact rural hospitals.
Modern Healthcare: Docs see smaller checks as Congress weighs options on Medicare cut (1/30) – If anyone were to ask members of Congress if doctors should be contending with Medicare pay cuts after a pandemic and a period of extraordinary inflation, and amid a chronic physician shortage, nearly all would say no. Yet, that is what happened on Jan. 1, and even powerful lawmakers who would like to ease or reverse that cut can't promise it will happen, even after recent actions to forestall hospital cuts and to extend expiring health care programs such as federally qualified health centers. frustrating time—including for those who are lawmakers, such as Sen. Dr. Roger Marshall (R-Kan.). "We're always on the table. Doctors are always the first ones on the chopping block up here, it seems like," Marshall said, citing data from the American Medical Association that estimates Medicare pays physicians 26 percent less than it did in 2001, when adjusted for inflation.
Health Payer Intelligence: A Look Inside the Four Most Common Value-Based Care Arrangements (1/25) – A simple explanation of value-based care is rewarding quality over quantity. However, value-based care arrangements differ in how they determine payments and the level of risk that is assumed. As health care organizations warm up to the idea of value-based care, CMS and commercial payers must choose which kind of arrangements they will offer to their provider partners. Value-based care models often fall into one of four categories: performance-based programs, bundled payments, capitation models, and shared savings programs. This article explains how payers reimburse providers under each arrangement.
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