Health Affairs: (10/12) – While varied in structure, alternative payment models serve as a mechanism to coordinate care across clinicians and provide flexibility in the way care is delivered; they have also proven successful in advancing the Triple Aim for adult populations and there is a large opportunity to use these advanced APMs to evolve the way we deliver care for children with medical complexity, reduce inequities, and improve the lives of patients and their families.
Medical Economics: (10/11) – A joint study between MGMA and Humana took a close look at value-based care and how practices approach it. The study, presented at MGMA 2022 conference in Boston, found that 67 percent of respondents agreed that value-based care was better in the level of quality care provided to patients. The biggest challenges identified to adding more value-based care contracts was a lack of staff resources, lack of control over patient care-seeking behavior, and lack of control over other providers.
Bain & Company: (10/11) – A recent Bain survey shows that 25 percent of US clinicians are considering switching careers, primarily due to burnout. Clinicians at management-led practices, such as those operated by a hospital, health system, or private equity fund are considerably worse off, giving a Net Promoter Score of six points, compared with 40 points for those at physician-led practices. To improve well-being, satisfaction, and retention, physicians report the most important criteria being better compensation, support to deliver high-quality patient care, a more manageable workload, flexible work arrangements, and more clinically focused job responsibilities.
RevCycle Intelligence: (10/11) – A recent retrospective, registry-based cohort study
published in JAMA Network Open found no association between participation in the Oncology Care Model (OCM) and the likelihood of patient receipt of novel therapies across a range of cancer types, despite stakeholder concerns that the OCM may have discouraged the use of novel anticancer therapies because of the model’s incentives to reduce overall cancer care spending. Additionally, the study found that Black patients were much less likely to receive a novel therapy and showed a large increase in the receipt of novel therapies for Black patients treated by oncologists in the OCM. “This finding raises the possibility that the OCM might have helped narrow racial disparities in patient access to novel therapies,” researchers wrote in the study. CMS’ Innovative Center recently revamped its strategy for designing alternative payment models and advancing health equity is now a pillar of its strategy and will be explicitly addressed in future models.
Healthcare Dive: (10/11) – About 35 percent of physicians experiencing burnout said those feelings significantly increased in 2022, and over half of polled physicians said they’ve considered leaving their current employer for another, up from 46 percent last year, according to a small survey out Friday from the MGMA
and Jackson Physician Search. A separate MGMA poll
also found 40 percent of medical practices surveyed had a physician resign or retire early due to burnout in the past year. This survey follows other recent reports analyzing the trajectory of burnout among physicians compared to other health care staff. To mitigate burnout and turnover, medical groups should address streamlining clinical workflows, managing workload equity amid staffing shortages and improving communication between physicians and administrators to encourage quality and honest feedback.
AJMC: (10/9) – Dr. Mark Fendrick, director of the value-based insurance design (V-BID) Center at the University of Michigan, suggests additional VBID elements that Congress should adopt. Dr. Fendrick hopes that Congress will build upon the insulin out-of-pocket cap of $35 implemented for Medicare, and extend the policy to commercial plans. Further, Fendrick would like to see the Internal Revenue Service expand the list of chronic disease services that could be covered on a pre-deductible basis.
RevCycle Intelligence: (10/7) – A recent study published in JAMA Health Forum found that ACOs that serve a high proportion of racial and ethnic minorities were more likely to exit the Medicare Shared Savings Program (MSSP) compared to ACOs serving mostly White beneficiaries. “This study underscores the importance of effective risk-adjustment methods that incorporate not only medical but also social risk factors to ensure that ACOs are not penalized for taking on patients with complexities, especially because a disproportionately high percentage of these patients are likely to be members of racial and ethnic minority groups,” researchers wrote. Future policy changes should have an equity-centered approach to ensure that the MSSP and other ACO programs, including the upcoming ACO REACH model, are not exacerbating racial disparities.
Health Affairs: (10/6) – This brief synthesizes key research studies on administrative spending and waste’s role in excess health spending. Administrative spending accounts for 15-30 percent of total health care spending, at least half of which is wasteful. The authors list targeted reforms which they believe are realistic and actionable in the near future including the creation of a centralized claims clearinghouse, a fully electronic prior authorization system, harmonized quality reporting, and the standardization of provider directories. The authors believe that there is a strong case for government intervention and that these policies would also lessen provider burden.
HIT Consultant: (10/5) – Whether organizations participate in government programs or create value-based care models in partnership with payers, they need to demonstrate that they are in fact providing high-value care. This requires tracking a wide range of metric including improved outcomes, lower costs, fewer barriers to care access, improved efficiency, higher patient and clinician satisfaction. Despite the clear value proposition for gathering data at the point of care, most provider organizations have been slow to do so at a large scale. Applying artificial intelligence to clinical workflows behind the scenes can ease the burden of data capture at the point of care while making data usable downstream for decision support and a range of administrative functions. This provides organizations with a single version of the truth that is preserved and that can be leveraged to improve clinical and financial outcomes, which is critical to success in any value-based care model. More importantly, it ensures that using technology no longer gets in the way of practicing medicine and instead serves as a tool that helps clinical staff make the rights decisions for the right patients at the right time.