Correcting The Blind Spot In Accountability: The Role Of Pharmacy Care

CMS stated that they seek recommendations about how the ACO program might evolve to “encourage greater care integration and financial accountability.”
Published Online: June 26, 2014

The Centers for Medicare and Medicaid Services (CMS) recently issued a Request for Information (RFI) to solicit suggestions about how to improve the Accountable Care Organization (ACO) programs. CMS stated that they seek recommendations about how the ACO program might evolve to “encourage greater care integration and financial accountability.”

The RFI explicitly stated that they seek information about how to better integrate Part D expenditures into ACO cost calculations to make pharmaceuticals part of the approach to care delivery and health care transformation.

The deadline for comments about encouraging Part D integration in ACOs has now passed. But the issue extends beyond ACOs. In addition, bundled payments and patient-centered medical home programs target hospitals and primary care providers to promote higher quality and lower cost care. All these programs have largely excluded prescription drug costs in their calculus, and offer no direct incentives for Part D plans to participate in and improve care.

Read the full story here:  http://bit.ly/1jirpoa

Source: Health Affairs



Feature
Recommended Articles
Approximately 70% of all Medicaid beneficiaries receive their healthcare services through managed care, and state Medicaid programs are required to report encounter data to a national database, but 8 states did not during fiscal year 2011, according to a new government report.
The report found that Medicare Part B spending per beneficiary in 340B hospitals was more than twice that of hospitals outside the program. Groups such as the Community Oncology Alliance have long warned that the 340B program, while essential, has grown beyond its original intent.
Bruce Feinberg, DO; Scott Gottlieb, MD; and Ted Okon, MBA, discuss the recent establishment of the Oncology Care Model by the CMS and compare its structure with the Community Oncology Alliance’s Oncology Medical Home model.
CMS has released additional guidance allowing for flexibility in claims auditing and quality reporting during the transition to the International Classification of Diseases, Tenth Revision and is working with the American Medical Association to educate providers.
Christine K. Cassel, MD, president and CEO of the National Quality Forum, sent her best wishes to The American Journal of Managed Care for its 20th year anniversary in publication.