News Clips
World Economic Forum: Eliminating ineffective spending on global health (11/22) – Most developed economies are nearing the limit of what they can afford to spend on health care, so how can ineffective spending on global health be eliminated? Answering this question is the mission of the World Economic Forum's Global Coalition for Value in Healthcare. The coalition partners with governments, leading companies, academia, and experts from around the world to showcase proof-of-concept of innovative approaches to people-centred healthcare. It is a global platform that develops effective best practices, shares lessons learned, and guides the development of value-based health system transformation. In 2021, the coalition welcomed its first four value-based healthcare innovation hubs. A year on, four more have joined, with initiatives delivering musculoskeletal, maternal, arthroplasty, and oral care in patient-centric models. Collectively, these organizations are improving the lives of hundreds of thousands of people.
JAMA: Medicare 2.0—A Vision for the Future of America’s Health Insurance Plan (11/21) – It is time for “Medicare 2.0”: a redesigned Medicare program that meets today’s health care challenges in a comprehensive, cost-effective, and equitable way. Medicare 2.0 should leverage this influence to significantly expand the primary care workforce. Medicare 2.0 should significantly increase payments for primary care to make it a more attractive career option, improve prevention, reduce emphasis on procedural interventions, and expand the nation’s primary care infrastructure. CMS should be conceptualized not as a public insurer but as an agency that finances population health. One critical element of this approach is integrating social investments into the Medicare mission: health care organizations should be given the flexibility to shift dollars from medical care into health-related social needs. This likely requires migration away from FFS as the predominant payment chassis.
Health Leaders Media: What’s Hindering Value-Based Care Growth in the U.S.? (11/21) – About 80 percent of physicians say they have an interest in participating in a value-based care program, according to a recent report from Bain and Company. However, that interest drops as the risk level to the provider rises. However, physicians say that they would be more disposed to adopt a value-based care model if they were guaranteed improved financial resources, medical coding and billing processes that are more effective, and adequate staff that can manage the reporting and outreach requirements. The majority of the physicians surveyed—37 percent—cite "sufficient financial resources" as the key factor in their willingness to adopt value-based care.
Axios: How medical inflation is ensnaring big employers (11/21) – There may be traction barring anti-competitive contracting practices between providers and health plans, said Geoff Manville, partner and senior director of government relations at Mercer, during a recent webcast. "There could be a lot of pressure next year to do even more with all signs sort of pointing to a big spike in costs next year for consumers and employers," Manville said. Antitrust regulation could focus more on provider consolidation, and there could be more efforts focused on drug price transparency and the role of pharmacy benefit managers.
Healthcare Innovation: Partnerships Begin Detailing ACO REACH Strategies (11/21) – Health systems and value-based care-focused companies are forming new partnerships to participate in CMS’ ACO REACH model. These groups are starting to provide details about their approaches to meeting the model’s care coordination and health equity targets. To better support care delivery and coordination for patients in underserved communities, each model participant must design and implement a comprehensive health equity plan that identifies its underserved communities and establishes initiatives to measurably reduce health disparities within their beneficiary populations.
Forbes: A New Plan Brings Clarity To Healthcare Price Transparency–Finally (11/21) – In health policy, there's nothing quite as opaque as price transparency. Insurance companies and hospitals tend to say there's no place for it in the healthcare sector, since medicine is more complicated than cars or groceries. Health care is expensive because prices are severed from market forces. The Cicero Institute's Jonathan Wolfson and Josh Archambault propose fixing this with model legislation they call the Patient's Right to Save Act. It would require hospitals to publish the cash price of their services. Second, the plan would require insurers to count payments to out-of-network providers toward a patient's deductible if those payments are less than the lowest in-network rate. Finally, the plan would direct insurers to share any savings a patient secures after hitting his or her deductible. By fostering competition, price transparency has delivered higher quality, lower prices, and better value in just about every sector of our economy. Health care has been an exception for decades—thanks largely to government policies that discourage price transparency.
Newsweek: Physician Burnout—the National Crisis No One Is Talking About | Opinion (11/21) – Burnout among American physicians is at an all-time high, according to a national study published in September by the Mayo Clinic. America's doctors are struggling to thrive in a broken health care system that has become more and more defined by red tape and bureaucracy. Outsized administrative burdens are imposed by both government and private insurance companies alike while patient care takes a back seat. Both physicians and patients are harmed by this status quo as burnout leads to lower qualities of care.
Axios: Sticking points slow health care's hyped shift to value (11/21) – The "shift to value-based care" was on everyone's lips at HLTH — but more than a decade after it began, ingrained provider dynamics and unequal market-wielding power continue to slow the fee-for-value train. The current fee-for-service system is essentially the opposite of the "apple a day" philosophy: It rewards high-cost and high-volume procedures and disincentivizes preventive care. A looming recession, skyrocketing costs of health care and a tight market are encouraging companies to dip their toes into value-based payments (VBP) models.
Fierce Healthcare: AMA adopts policy to curb influence of private equity on new doctor training (11/18) – The American Medical Association (AMA) released Thursday a new policy surrounding private equity’s role in medical education. The goal of the policy is to protect residents in case a teaching hospital gets acquired, including ensuring that funds are transferred after a facility closure. The organization warned that private equity firms invest in health care to make a profit by acquiring hospitals and practices and then trimming operations. AMA’s policy comes amid heightened scrutiny of private equity’s role in health care overall. The Federal Trade Commission and the Justice Department both signaled closer scrutiny of private equity deals amid concerns over the impact of such mergers on quality and patient access to care.
Commonwealth Fund: Stressed Out and Burned Out: The Global Primary Care Crisis (11/17) – This brief presents the first findings from the 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians to explore the effects of the pandemic on the primary care workforce across nations. Across the 10 high-income countries included in this study, most physicians reported increases in their workload since the beginning of the pandemic. Younger physicians (under age 55) were more likely to experience stress, emotional distress, or burnout and, in nearly all countries, were more likely to seek professional help compared to older physicians. Physicians who experienced stress, emotional distress, or burnout were more likely to report providing worse quality of care compared to before the pandemic.
RevCycle Intelligence: KLAS: Epic, Arcadia, Innovaccer Earn Top Marks for Value-Based Care (11/17) – According to a new report from KLAS, payers and providers are looking to expand their value-based care contracts across business lines, and most are looking to do so with a fewer number of strategic vendor partnerships. There is room to grow when it comes to value-based care reimbursement, the report indicated. While the sample of health care executives surveyed mostly hailed from more progressive organizations, about half receive one-fifth of less of their revenue from value-based reimbursement. Only those in ACOs and clinically integrated networks said they receive over 90 percent of revenue from value-based reimbursement. The health care executives overwhelmingly expect revenue from value-based care contracts to increase in the next three years as new opportunities for contracting emerge and market pressures from payers and the government propel them toward value-based care. To achieve greater value-based care penetration, health care organizations are using strategic vendor partnerships.
Primary Care Collaborative: PCC’s New 2022 Evidence Report Analyzes Trends In Patient Access to Usual Source of Care (USC) (11/16) – This robust evidence base documents better population health outcomes, more equitable care, and lower cost of care across all demographic groups who have an ongoing relationship with primary care. An ongoing relationship can enable clinicians to better know and understand their patients’ needs and preferences, to build trust and rapport, and may result in higher patient satisfaction. Despite some factors that may enhance USC, the 2022 Primary Care Collaborative (PCC) Evidence Report shows that the percentage of Americans with an ongoing primary care relationship has been declining, falling 10 percent between 2000-2019, from 84 percent to 74 percent. In 2020, there was a slight uptick in USC to 75 percent, potentially attributable to the pandemic. It is not known if this will be a one-time increase or a change in trend.
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