News Clips
The Hill: A four-point strategy to disrupt and reinvent primary care (12/6) – Many small group primary care practices have consolidated into larger organizations that controlled health care delivery as well as financial management. Hospitals have also consolidated and begun to employ many physicians, with tight management that controlled and directed care. To improve outcomes for patients and control costs, we must reposition the patient at the center of the decision-making process. Providing transparency in pricing and introducing more competition in a marketplace in which the patient is at the center of the process is needed not only in primary care but throughout other areas of medicine. A direct primary care physician-patient relationship that controls primary care services, with insurance only tangentially involved, is the only viable pathway to save and reinvent primary care.
JAMA: Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes (12/6) – In this cross-sectional observational study of primary care physicians, merit-based Incentive Payment System (MIPS) scores were inconsistently related to performance on process and outcome measures, and physicians caring for more medically complex and socially vulnerable patients were more likely to receive low MIPS scores, even when they delivered relatively high-quality care. These findings suggest that the MIPS program may be ineffective at measuring and incentivizing quality improvement among US physicians.
Health Affairs: Use Of Area-Based Socioeconomic Deprivation Indices: A Scoping Review And Qualitative Analysis (12/6) – This comprehensive scoping review identified fifteen indices of area-level deprivation used in recent public health and health outcomes research in the US, highlighting the variety of tools available. Developing an understanding of the key characteristics of each index, and the variability between indices, is an important step for public health practitioners and health outcome researchers to take before index selection and application. The three characteristics we consider most important in comparing the indices are the input variable domains, the geographical definition of neighborhood, and the nature of the output measure or measures.
National Law Review: 2023 Physician Fee Schedule Final Rule Supports Health Equity Through Investments in Accountable Care Organizations (12/6) – Since its inception, the MSSP has demonstrated a long-standing focus on appropriate care delivery and care coordination for traditional Medicare beneficiaries. The final rule serves to expand the reach of that focus to additional Medicare beneficiaries, especially those in rural and underserved communities, through the implementation of these policy changes
BMC Health Services Research: Evaluating clinician experience in value-based health care: the development and validation of the Clinician Experience Measure (12/6) – Clinicians’ experiences of providing care constitute an important outcome for evaluating care from a value-based health care perspective. The clinician experience measure (CEM) is an instrument to capture clinicians’ experiences of providing care across a health system. The CEM provides a useful tool for health care leaders and policy makers to benchmark and assess the impact of value-based care initiatives and direct change efforts.
The Hill: Medicare is central to fixing health care and the federal budget (12/4) – Although Medicare pays lower rates for most medical services compared to commercial insurance because of strict regulations, the program does not have costs fully under control. Medicare’s extensive rules influence how hospitals, physician practices, and other suppliers of services organize themselves to care for patients. In general, Medicare’s fee-for-service (FFS) billing system has encouraged fragmentation rather than coordination, which leads to higher costs. Medicare is not exempt from the resulting absence of discipline.
Health Affairs: Growth Of Value-Based Care And Accountable Care Organizations In 2022 (12/2) – Across all payers, ACO participation has continued, but growth in the number of new ACOs, new ACO contracts, and ACO-covered lives has slowed. By the end of 2022’s first quarter, there were 1,010 known ACOs, with 1,760 public and private ACO contracts, covering more than 32 million lives. Going forward we expect several trends: continued financial tightening and movement toward downside risk, the opening of new models to help move from FFS in ways that may not require providers to take full population risk, and more incentives for ACOs, likely leading to an increase in applicants.
Health Affairs: Value-Based Payment As A Tool To Address Excess US Health Spending (12/1) – The relatively modest results of CMMI’s value-based payment models may be related more to challenges in design and implementation than to the fundamental approach. Notably, there is strong CMMI support for addressing many of the criticisms that experts have identified in Medicare’s rollout of these models, including technical challenges related to benchmark setting and risk adjustment. In light of a growing body of research analyzing the ability of value-based payment models to serve traditionally underserved communities and to support improvements related to social needs, CMS has also highlighted ACOs as a potential mechanism for improving health equity and has made health equity an area of focus for other value-based payment programs.
National Academy for State Health Policy: Policy Tools to Lower Hospital and Health System Costs (12/1) – Consolidation of hospitals and providers has created dominant health systems that can use their market power to include anticompetitive clauses in contracts with health plans, which help to drive up health care prices. Insurers may lack the leverage necessary to negotiate more flexible contract terms that could expand in-network providers, increasing competition and consumer choice that could lead to lower reimbursement rates. Prohibiting anticompetitive contract clauses allows insurers a better opportunity to navigate an already consolidated health market.
The Hill: Medicare is cutting critical cancer care funding — it’s time for Congress to step in (11/30) – Consolidation raises out-of-pocket costs for patients and increases costs to the overall health care system with no evidence of increased quality or efficiency. Policymakers say they want to lower health care costs, yet CMS is once again pursuing policies that will exacerbate consolidation pressures. Oncology has one of the highest rates of consolidation, largely driven by payment disparities across different sites of service. Fortunately, Reps. Bera, MD (D-CA) and Bucshon, MD (R-IN) have introduced bipartisan legislation, which would go a long way toward stabilizing struggling practices and safeguarding cancer patients’ access to high value care. By blocking much of these cuts from coming into effect on Jan. 1, the Supporting Medicare Providers Act of 2022 (H.R. 8800) would extend a critical lifeline to physicians, including the community oncologists that thousands of Americans rely on for quality cancer care.
Forbes: The Importance of Creating Value-Based Equitable Care (11/30) – Value-based and accountable care has been in prevalence for more than a decade, and the success of its meaningful use saw the increased adoption of EMRs as well as increased investment in shared savings, bundled payments and population risk. The recent pandemic exposed health iniquities across several parts of the country, with CMMI taking a center stage to promulgate changes and encourage more equitable care across the nation. In this article, we study the key characteristics of clinically integrated networks that can optimally exploit data and analytics insights across the care spectrum in order to hone into patient preferences, behavioral motivations and reachability as well as forecast and monitor payment impact, optimize provider performance and close in adherence on care guideline both by provider and member.
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