Alternative Payment Models

As new treatments and technologies evolve, it is very important that radiation oncologists have a new alternative payment model for reimbursement, said Shalom Kalnicki, MD, FASTRO, FACRO, professor and chairman, radiation oncology, Montefiore Einstein Center for Cancer Care and Albert Einstein College of Medicine.

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with today’s approaches to value assessment.

Jason Mitchell, MD, chief medical and clinical transformation officer, Presbyterian Healthcare Services, discusses the role primary care will play in the transition to value-based care.

Devin Incerti, PhD, lead economist, Innovation and Value Initiative, discusses the need for global value assessments to be adaptable for countries that place emphasis on certain values.

This week, the top managed care news included the Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention.

The Oncology Care Model (OCM) is pushing cancer centers and cancer programs to make the changes they knew were needed to improve care delivery and patient experiences, said David Ortiz, OCM program director at Montefiore Einstein Center for Cancer Care.

Creating a healthcare system that prioritizes a well-informed consumer and rewards improvements in quality requires overhauling the current system. Through a series of programs and initiatives, CMS, under Administrator Seema Verma’s leadership, is trying to fix some of the issues that plague the current US health system and make accessing care challenging for patients.

The long time between when a performance period ends and when the report comes out in the Oncology Care Model (OCM) can make it difficult to measure the impact specific changes are making, said David Ortiz, OCM program director at Montefiore Einstein Center for Cancer Care.

The Oncology Care Model (OCM) has set off a ripple of change in cancer care that extends beyond the patients who are in the model, said David Ortiz, OCM program director at Montefiore Einstein Center for Cancer Care.

Implementing new payment models is really complicated, and the private sector is not doing as much as the public sector, said Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

The first day of the 2019 Community Oncology Conference, the major annual meeting of the Community Oncology Alliance (COA), featured an update on its effort to find alternatives to CMS' Oncology Care Model.

Today, the Health Care Payment Learning & Action Network (LAN) launched the Roadmap for Driving High Performance in Alternative Payment Models. The roadmap is designed as a customizable, interactive tool to assist healthcare payers, providers, and various stakeholders in navigating alternative payment model (APM) implementation.

Everyone at the practice is vital to the success of value-based care, which is really patient-centered care, said Jessa Dunivan, patient services manager, Northwest Medical Specialties.

In a session at the Academy of Managed Care Pharmacy Annual Meeting held March 25-28 in San Diego, California, speakers discussed the value-based contract process in Medicaid from both the manufacturer and the payer perspectives.

A diverse panel of representatives from different practice models provided insights into what has worked for them and what has not in trying to improve cancer care. The discussion took place in Washington, DC, at the Association of Community Cancer Centers

Among the survey’s crucial finding are that value-based contracts are not yet seeing marked success. According to the survey results, 39.8% of respondents said that the majority of value-based relationships within the healthcare market will not contain both upside and downside shared risk for another 3 to 5 years.

Care coordinators are a support system for the clinical and the clerical teams to make sure that nothing falls through the cracks, explained Jessa Dunivan, patient services manager, Northwest Medical Specialties.

Current population health efforts have been hampered by the misalignment of accountability. Thus, population health management will improve when shared accountability among stakeholders is achieved.

There has always been interest in bundled payments, and now the industry is moving toward implementing more, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.

This article describes how one accountable care organization (ACO) created a risk-adjusted algorithm to evaluate current and potential candidates for skilled nursing facility partnerships.

How to improve patient-reported measurement in oncology valued-based care is the focus of a new report from The National Pharmaceutical Council and Discern Health.

Although safety net organizations are eligible for some two-thirds of federal payment reform programs, fewer than 20% of these programs directly target the safety net.

There is a lot involved if an accountable care organization (ACO) decides to switch from Medicare Shared Savings (MSSP) to Medicare Advantage, but Medicare Advantage offers more benefit design flexibility, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

Not only are there more dollars being place in value-based contracts, but the healthcare community is starting to see the benefits of these programs, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.

We surveyed biopharmaceutical manufacturers and payers to understand the prevalence and characteristics of value-based payment arrangements, as well as their implementation obstacles and success factors.

How can the health industry ensure that cutting-edge gene therapies and other curative treatments get to the patients that need them, without leaving payers financially exposed? Representatives of payers and biotechnology companies discussed some of the novel discussions that are taking place as they work through issues of expense and access during “Paying for Cures: Ensuring patient access and system sustainability," a 1-day event in Washington, DC.

As CMS prepares to implement its new Pathways to Success program (formerly Medicare Shared Savings Program) for accountable care organizations (ACOs), some ACOs may consider Medicare Advantage a more beneficial arrangement, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

While not every doctor is successful in value-based contracts, there is a shift in the right direction to more value-based care, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.

Compared with other payment models, like bundled payments or the Comprehensive Primary Care Program, accountable care organizations (ACOs) have done a better job of saving money, said Rob Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care.