City Journal: Hoosier Savings: Indiana leads the way in tackling health-care costs (5/16) – The House Energy and Commerce Committee wants to tackle rising health care costs. Policymakers should consider how Indiana has recently handled the issue. Indiana families pay some of the nation’s highest health care costs. A key reason why Indiana’s hospital prices are so high is because large hospitals have merged with competitors and become powerful regional monopolies. According to RAND’s study, the state’s hospital market is controlled by just six chains. One of the reasons costs go up is because hospitals frequently engage in what is known as “dishonest billing.” This occurs when hospitals secretly reclassify a doctor’s office that they own as a hospital-based setting, so they can charge patients and taxpayers higher prices. Earlier this month, the Indiana legislature passed a proposal to end dishonest billing by requiring hospitals to disclose to insurers the location where care was performed.
Paragon Institute: Medicare’s Fitful Quest for Value-Based Care (5/16) – This paper provides background on the enactment and implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which made significant changes to clinician payment in Medicare. It also highlights some of the shortcomings of the law and the Quality Payment Program (QPP) it created. While MACRA’s goal of moving Medicare beyond fee-for-service (FFS) toward paying for value was reasonable and broadly popular, its enactment has not transformed the quality of Medicare services as promised. Congress and the executive branch have been forced to make changes and exemptions to MACRA, but a long-term approach to clinician payment is needed.
Medical Economics: Value-based care models can help close care gaps for Medicaid beneficiaries (5/15) – Value-based care is a health care delivery model that compensates providers based on patient health outcomes rather than the current FFS model driven by service volume. By incentivizing providers to focus on preventive care, care coordination, and managing chronic conditions, value-based care can help improve the overall health of their patient panel, thus lowering the cost of care by reducing the need for hospitalizations and emergency department visits. Additionally, value-based care can improve access to care for Medicaid beneficiaries by ensuring they receive the proper care at the right time, in the right place. While value-based care is particularly well suited for providers serving Medicaid patients, its use does present challenges, particularly for independent primary care practices in low-income communities. Medicaid is less lucrative, is difficult to administer, and health literacy issues often persist.
AJMC: Tacking Upwind: Reducing Spending Among High-risk Commercially Insured Patients (5/15) – The study examined a commercial accountable care organization (ACO) population and then assessed the impact of an integrated care management program on medical spending and clinical event rates. The population was healthy on average but included several hundred high-risk patients. After adjustment, patients within the ACO’s integrated care management program for high-risk patients had lower monthly medical spending (by $1,361 per person per month) as well as lower emergency department visit and hospitalization rates compared with similar patients who had yet to start the program. These findings offer hope for reducing the growth of spending within commercially insured populations.
Brookings: Assessing recent health care proposals from the House Committee on Energy and Commerce (5/12) – On April 26, 2023, the House Energy and Commerce Subcommittee on Health held a bipartisan hearing on strategies to improve transparency and competition in health care markets. At the hearing, the Subcommittee considered 17 bills on a range of topics, notably including proposals to expand site-neutral payments for certain ambulatory services and to improve health system transparency. This article analyzes the site-neutral payment and transparency proposals in depth. Many of these proposals, particularly those that would expand site-neutral payments in Medicare and increase transparency around the ownership of health care providers, would improve the U.S. health care system or enable research that could lead to such improvements.
Healthcare Dive: Rethinking the area deprivation index: a call for more effective measures to promote health equity – op-ed by Srilekha Palle, Independent Women’s Forum (5/12) – Although the Area Deprivation Index (ADI) is one tool for identifying underserved communities and targeting support to organizations caring for disadvantaged and marginalized groups, its implementation has significant limitations that may exclude many communities where resources and access to high-quality, coordinated care are most needed. Utilizing the ADI to measure social risk factors in models that decide health plan payments exacerbate payment inequalities. Moreover, using home value to measure socioeconomic disadvantage may penalize low-income people and communities of color and mask the medical needs of these populations. One potential solution is to recalibrate the ADI to a more local level, adjusting for variations in the cost of living or considering using an absolute measure such as life expectancy to identify health disparities.
RevCycle Intelligence: AMGA: Pharmacy Claims Data Key to Value-Based Care Progress (5/12) – Lawmakers have their eyes on pharmacy benefit manager (PBM) reform, but one bill is looking to take it a step further by requiring commercial payers to share pharmacy claims data with providers to progress value-based care. Sen. Mullin (R-OK) recently offered an amendment to the Pharmacy Benefit Manager Reform Act (S. 1339), which was first introduced by Senate HELP Committee Chair Sanders (I-VT) and Ranking Member Cassidy (R-LA) late last month. The American Medical Group Association (AMGA) said the amendment requiring commercial payers to share data with payers is a major move for value-based care. "The passage of this amendment will ensure that multispecialty medical groups and integrated delivery systems have access to this data, which provides a more comprehensive view of their patient's health, which is key to providing better care."
Health Affairs: Why Current 'Food Is Medicine' Solutions Are Falling Short (5/12) – Amid the gradual transition to value-based care, alternative payment models should be considered potential funding mechanisms for food is medicine (FIM) services. The new ACO REACH model encourages coordination across health care providers to deliver high-quality, equitable care. In this innovative model, providers voluntarily work together to create an individual care plan with supplemental services reimbursed through value-based metrics, giving providers more flexibility to use dollars in ways that meet patients’ needs. Beyond this experimental model, other ACOs could include routine screenings for food insecurity and nutrition literacy along with evidence-based services such as medically tailored foods and culinary medicine programs that can improve patient outcomes. These frameworks can help health care providers and patients use important nutrition-focused health services.
Health Affairs: Nine Health Care Megatrends, Part 3: Patient Care (5/11) – Over the next five years, primary care will be enhanced to provide more comprehensive care, manage patients, and reduce costs. This comprehensive model will greatly expand to cover many more patients across the country as primary care practices are entrusted with greater control over specialty referrals and site-of-service decisions. The trend toward comprehensive primary care has already begun, driven by a flow of substantial resources. One source of funding is the tremendous expansion of Medicare Advantage. In addition, the CMS is intending to enroll all of its FFS beneficiaries into accountable care organization-type arrangements by 2030. The best will also have most patients under value-based payments with substantial, salient incentives for cost savings, quality, access, and equity.
Politico: CMS Innovation Center under the microscope (5/11) – Republicans are questioning the overall benefit of CMMI, which has started incorporating health equity measurements into its model efforts in recent years. “CMS has tested more than 50 models since its creation,” said Rep. Adrian Smith (R-NE). “Despite millions of taxpayer dollars spent setting up and evaluating these models, only six of these were found to have delivered statistically significant savings.” CMMI launched a strategic refresh in 2021 that set an ambitious goal to have every Medicare FFS beneficiary in an accountable care relationship by 2030. The center also wants to develop new models that focus not just on delivering savings to Medicare but also improvements to care and health equity.
Health Affairs: The Neighborhood Atlas Area Deprivation Index For Measuring Socioeconomic Status: An Overemphasis On Home Value (5/10) – As we investigated the ADI for use in New York State, some limitations became apparent. Although 17 variables are included in the ADI, it is driven by variables characterized in dollar values and is predominated by a single variable—median home value. Because the variables are not standardized before weighting, the ADI overemphasizes the variables measured in dollars, particularly median home value. This can be especially problematic when considering quality assessment, funding, and resource allocation in regions with large variations in cost of living, and it may result in under-resourcing for disadvantaged communities with high housing prices. The Neighborhood Atlas could be improved by standardizing the units of the ADI variables before creating the index and by adjusting for regional variation in the cost of living.