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News Clips
Med City News (10/15) Finding the Cure for Data Interoperability in Value-Based Care – As the health care industry transitions from FFS to value-based care models, the need for data interoperability continues to rise. Enterprise data management systems designed for our health care future offer a comprehensive solution by centralizing and enriching data from disparate sources, enabling more seamless communication and informed decision-making. These systems also empower payers and providers to deliver coordinated, patient-centered care. Embracing enterprise data management – and technologies like AI to harness and make sense of all the available data – will enhance care quality, optimize operations, and ultimately support the successful adoption of value-based care models.
Modern Healthcare (10/15) CMS' 2030 value-based care goal at 'inflection point' – The Biden administration's goal to move all Medicare beneficiaries into accountable care arrangements by 2030 may be just within reach, but is at a turning point. The most immediate question that could determine the initiative's future is whether Congress extends a bonus program meant to help providers transition away from FFS reimbursement and toward value-based payment before it expires this winter. But longer-term issues have risen to the fore, such as how success is measured and rewarded, and both Congress and the Centers for Medicare and Medicaid Services will have to make adjustments to reach the final goal within five years, industry sources and analysts contended.
Health Affairs (10/9) Physician Payment Reform in Medicare: Putting the Pieces Together – This Forefront article considers the fundamental role of APMs in advancing goals that are otherwise challenging to pursue through FFS reforms alone. It then delves into the design of two pieces of physician payment reform that are more related than they may seem and directly interact with broader population-based payment reforms: the APM bonus and primary care payment reform. An overarching theme is that appreciating how various pieces need to be crafted to fit together is crucial to elucidating a way forward that effectively achieves policy objectives.
Medical Economics (10/9) A wake-up call for physician-owned practices – Independent physicians must consciously work to preserve the human touch in their practices. This means using AI to enhance, not replace, the patient experience. For example, AI can be used to streamline administrative tasks, freeing up more time for physicians to spend with their patients. It can also provide valuable data insights that enable more personalized care. However, it’s essential that the final decisions remain in the hands of the physician, ensuring that patients feel heard, valued, and respected. Physicians must take a proactive approach—staying informed about AI developments, advocating for ethical AI use, and ensuring that AI remains a tool to support, not replace, their medical judgment.
Health Affairs (10/8) Does Higher Spending On Primary Care Lead To Lower Total Health Care Spending? – High-quality primary care is the foundation of a high-functioning health care system. It ensures patients have access to essential services, prevents emergency department visits and hospital admissions, leads to better health outcomes, and improves quality of care and equity. The secret sauce that allows high-quality primary care to deliver on all these benefits is long-term relationships between patients and their primary care clinicians and other team members. Trust allows patients and clinicians to use time as a diagnostic tool, rather than reactionary tests, procedures, or referrals; long-term relationships bring cohesiveness to a health care journey that is otherwise often fragmented in the US.
Fierce Healthcare (10/7) UnitedHealth report calls out policy changes to accelerate shift to value-based care – The health care industry is making the push toward greater adoption of value-based care, yet it's not a secret that progress has been slow-moving. With that backdrop, UnitedHealth Group has released its latest "A Path Forward" report, which is a biennial look at progress in the shift to value. The paper includes dozens of policy recommendations the team believes can accelerate that transformation. The report's recommendations address a range of challenges hindering value-based care, access and patient experience, UnitedHealth said. For example, it suggests that regulators update payment models under the Medicare Access and CHIP Reauthorization Act to assist physicians in building the infrastructure necessary for value-based models.
Medical Economics (10/7) The lost meaning of ‘quality’ and ‘cost’ in value-based care – Over the past decade, value-based care (VBC) has emerged as a popular alternative to the traditional FFS model. Despite its growing popularity, the anticipated benefits in cost reduction and quality improvement have not been realized for the broader population. So, why isn’t VBC achieving its intended effects at scale? A key issue is that we’ve lost sight of the true meanings of “quality” and “cost” when it comes to health care. Genuine quality indicators, which are crucial for assessing patient outcomes, have been overshadowed by more easily quantifiable and manipulable process metrics. Meanwhile, the real costs of care are often hidden behind a zero-sum game of savings passed between payer and provider —savings that patients rarely see. To truly improve cost efficiency and quality in health care, organizations must address four main challenges.
STAT (10/5) Philanthropists Laura and John Arnold warn: Beware hospital consolidation – Under current law, Medicare pays two to three times more for routine treatments administered in a hospital-owned outpatient clinic than it does for those in an independent doctor’s office. In many situations, paying hospitals more makes sense. Thankfully, even in today’s highly polarized Washington, there is bipartisan support to address costs by advancing what’s called site-neutral payment reform—which would ensure patients pay the same price for routine services regardless of whether they’re provided in a hospital-owned physician’s office. One such bill — the Lower Costs, More Transparency Act — passed the House of Representatives in late 2023 with overwhelming bipartisan support. And there is room for Congress to go even further and enact comprehensive site-neutral payment reforms that could save Medicare more than $150 billion over the next decade.
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