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ACO Initiatives Test Pharma's Traditional Sales Model
The US healthcare system's shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government—led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
The US healthcare system’s shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government—led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
About 10% of the US population, or 34 million people, will be enrolled in either government-funded or commercial ACOs by 2015, according to consultants, up from 12 million in 2013. While the numbers are small some estimate that, for a variety of reasons, ACOs’ influence is much greater, with up to 170 million covered lives in the US affected either indirectly or directly.
The Centers for Medicare and Medicaid Services (CMS) established the ACO initiative, which essentially aim to improve coordination and management of patients while lowering the cost of care. Key to their effectiveness are financial rewards for meeting or exceeding pre-determined quality and cost metrics—or, in some models, penalties for falling short. The degree to which providers have a stake in the game and the kinds of goals they must meet vary depending on the model they follow and whether the organization is aligned with the CMS or a private insurer.
Read the full story here: http://onforb.es/T9AicW
Source: Forbes
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
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Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
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Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
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Reducing Low-Value Care Is Hard, but What About Just Not Paying for It?
March 14th 2024After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.
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