February 23rd 2024
While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.
February 14th 2024
Moving Value-Based Payment Models to a Disparities Paradigm
February 28th 2018An opinion piece in the Annals of Internal Medicine makes the case for shifting value-based payment models to address the issue of healthcare disparities directly into hospitals’ financial calculations, incentivizing institutions to address the issue head-on without sacrificing quality.
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Value-Based Contracts Significantly Decrease Price of Co-Pays for Medications
February 27th 2018Commercially insured individuals with health plans with value-based contracts for diabetes, high cholesterol, and HIV medicines had average co-pays that were 28% lower for those prescription medications compared with people on other plans, according to a report from the Pharmaceutical Research and Manufacturers of America (PhRMA).
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Value-Based Programs Bring Positive Financial Results, Yet Providers Tread Cautiously, Survey Finds
February 20th 2018A survey of healthcare executives finds that ongoing issues with interoperability are holding back the transition to value-based reimbursement mechanisms. Humana's Chief Medical Officer, Roy A. Beveridge, MD, said the healthcare system must demand the same level of seamlessness seen in the banking industry.
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AHA Asks CMS to Delay New Bundled Payment Model
February 19th 2018The American Hospital Association (AHA) recently asked CMS to delay the application deadline for its new bundled payment model by about a month so that additional programmatic information can be communicated to healthcare providers, systems, and clinicians. The AHA asked for the new information to be released by March 1 and for the program’s application deadline to be delayed from March 12 to April 16.
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Working Paper Identifies Hospital Cost Shifting Resulting From Medicare Penalties
February 17th 2018A new National Bureau of Economic Research working paper identified potential hospital cost shifting and that hospitals penalized by the Hospital Readmission Reduction Program and the Hospital Value-Based Purchasing Program actually had an increase in average payments of 1.5%.
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Survey Identifies Barriers to Achieving Value-Based Care Models
February 16th 2018Value-based care and interoperability continue to progress in the United States, but barriers that limit sharing of clinical information among hospitals, physicians, and health plans remain, according to a study by the Healthcare Financial Management Association (HFMA) and sponsored by Humana.
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More Healthcare Execs Accounting for Social Determinants of Patients' Lives, Survey Finds
February 15th 2018The results of a new survey, published in a recent white paper by HealthCare Executive Group and Change Healthcare, showed that a majority of executives are increasingly adopting social determinants of health into their programs.
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ACO Quality Over Time: The MSSP Experience and Opportunities for System-Wide Improvement
From 2013 to 2016, Medicare Shared Savings Program accountable care organizations (ACOs) improved quality. Continued infrastructure development funding, better relationships with postacute care facilities, and shared learnings among diverse ACOs would maximize quality improvement.
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Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings
From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.
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This Week in Managed Care: February 9, 2018
February 9th 2018This week, the top managed care stories included Indiana being approved as the second state to implement work requirements in Medicaid; research found 5-year survival rates for cancer are increasing; coverage from the American Society of Clinical Oncology's 2018 Genitourinary Symposium.
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Regional Benchmarking or Regional Bonus? Sustainability in the Medicare Shared Savings Program
February 6th 2018In healthcare, the “volume-to-value” movement seeks to align the interests of healthcare providers with the societal triple aim of better care, better health, and lower costs. The devil, as always, is in the details.
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Terrill Jordan on Implementing OCM: Take It Step by Step
February 6th 2018Before undertaking something like implementing the Oncology Care Model, practices should understand the scope of the project and the overall importance it can have for patient care, said Terrill Jordan, CEO of Regional Cancer Care Associates.
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Dr Peter Aran Discusses Year 1 Feedback on OCM
February 5th 2018When you have constant evolving contract, there are changes, and so some of the feedback I’m getting is that sometimes it’s hard to keep up with the changes, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.
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This Week in Managed Care: February 2, 2018
February 2nd 2018This week, the top managed care news included President Donald Trump vowing to lower drug prices during his State of the Union address; 3 corporate giants joined forces on healthcare; and CAR T-cell therapy was named the cancer advance of the year.
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Dr Peter Aran on What Oncologists Implementing OCM Can Learn From Existing Models
January 24th 2018Over the next years, these spheres (ACOs, primary care, and oncology) that are going on in CMMI need to be coalesced together so that when we have learning collaboratives, not only do we have learning collaboratives within each of these spheres, but we learn from each other in these similar projects, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.
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The Fallacy of Estimating OCM Target Prices
January 22nd 2018Estimating episodic target prices for each patient in the Oncology Care Model (OCM) can be challenging and time consuming. Applying that time to quality-focused care management tactics, based on observed utilization and patient outcomes, may wind up being more valuable, and help to reduce unnecessary spending.
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MACRA Continues to Catalyze Movement Towards Value
January 18th 2018Given that 2018 marks the last year of the transition-year policies, implementation challenges identified during the first 2 years of Medicare Access and CHIP Reauthorization Act (MACRA) preparation and execution must be addressed to ensure effective delivery of high-value care as intended.
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David Merrill and John Robinson Discuss Barriers to APMs, Factors of Interest
January 15th 2018The ability to have a plan that’s going to work and be large enough that it makes sense for those involved is a barrier for employers who want to pursue alternative payment models, said David Merrill, HR benefits manager, Volusia County, Florida, and John Robinson, CEBS, REBC, RHU, president and CEO, RobinsonBush.
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