Alternative Payment Models

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Doing Things Differently: Wilfong Moves to Thyme Care
Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

Thyme Care logo | Image : Thyme Care
Beyond Navigation: Thyme Care Ready for Heavy Lifts to Make Value-Based Care Work

October 12th 2024

Patient Navigation | Image credit: CDC
Setting the Course for Comprehensive Care Navigation in Oncology

October 11th 2024

Patient Assignment and Quality Performance: A Misaligned System
Patient Assignment and Quality Performance: A Misaligned System

October 9th 2024

USON logo | Image: The US Oncology Network
Clinical Trials Won’t Cause Financial Harm for Practices in Medicare Payment Models, Study Finds

June 28th 2024

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September 20th 2019

The Cost of Learning: Participating in APMs Despite Projected Financial Losses

Jessica Walradt, MS Hannah Alphs Jackson, MD, MHSA Brian Walsh, BA David Manning, MD
This article explores Northwestern Medicine’s decision to participate in a Medicare alternative payment model (APM) despite projected losses.
Lessons From the Field: How Practices Are Succeeding Under OCM
September 18th 2019

Lessons From the Field: How Practices Are Succeeding Under OCM

Jaime Rosenberg
As rising drug costs continue to take up a larger portion of the total cost of care, practices in the Oncology Care Model find themselves in control of a shrinking portion of total costs, according to anecdotes from an academic medical center and a community-based practice during the National Comprehensive Cancer Network’s Policy Summit held September 12 in Washington, DC.
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September 10th 2019

Physician-Initiated Payment Reform: A New Path Toward Value

Suhas Gondi, BA Timothy G. Ferris, MD, MPH Kavita K. Patel, MD, MSHS Zirui Song, MD, PhD
Physician groups have begun designing alternative payment models for their own specialties, proposing that CMS include financial risk, funding for new technologies, and legal waivers.
Dr Jeroen Jansen Outlines Challenges With Incorporating Novel Elements in Value Assessment
August 27th 2019

Dr Jeroen Jansen Outlines Challenges With Incorporating Novel Elements in Value Assessment

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with incorporating more novel concepts of value into value assessment.
Who's Next in Line for New Payment Models? Everybody!
August 21st 2019

Who's Next in Line for New Payment Models? Everybody!

Rhonda Henschel
Dr Jeroen Jansen Discusses Value-Assessment Questions Posed by Curative Treatments
August 14th 2019

Dr Jeroen Jansen Discusses Value-Assessment Questions Posed by Curative Treatments

With the increasing prevalence of more expensive, potentially curative therapies, there comes the question of can we still afford expensive interventions that are that valuable, explained Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative.
Dr Brett McQueen: Multiple-Criteria Decision Analysis Can Aid in Reimbursement, Coverage Decisions
August 7th 2019

Dr Brett McQueen: Multiple-Criteria Decision Analysis Can Aid in Reimbursement, Coverage Decisions

R. Brett McQueen, PhD, assistant professor, Department of Clinical Pharmacy, Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado, explains how multiple-criteria decision analysis be used to aid in coverage and reimbursement decisions for high-cost, innovative therapies.
Dr Shalom Kalnicki on the Importance of a Radiation Oncology APM
August 3rd 2019

Dr Shalom Kalnicki on the Importance of a Radiation Oncology APM

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.
Dr Jeroen Jansen on Challenges With Current Approaches to Value Assessment
August 1st 2019

Dr Jeroen Jansen on Challenges With Current Approaches to Value Assessment

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with today’s approaches to value assessment.
Dr Jason Mitchell Discusses the Evolving Role of Primary Care in Value-Based Care
July 31st 2019

Dr Jason Mitchell Discusses the Evolving Role of Primary Care in Value-Based Care

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.
Dr Devin Incerti on the Need for Global Value Assessment to Be Adaptable
July 27th 2019

Dr Devin Incerti on the Need for Global Value Assessment to Be Adaptable

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 in Managed Care: June 14, 2019
June 14th 2019

This Week in Managed Care: June 14, 2019

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.
David Ortiz Explains How OCM Is Changing Cancer Care Delivery
June 9th 2019

David Ortiz Explains How OCM Is Changing Cancer Care Delivery

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.
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May 31st 2019

Seema Verma Envisions a US Health System That Shares Data, Is Truly Value-Based

Laura Joszt, MA
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.
David Ortiz Discusses Making Adjustments, Reacting to Performance Period Reports in OCM
May 28th 2019

David Ortiz Discusses Making Adjustments, Reacting to Performance Period Reports in OCM

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.
David Ortiz Highlights Changes in Care as a Result of OCM
May 16th 2019

David Ortiz Highlights Changes in Care as a Result of OCM

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.
Dr Michael Kolodziej Remarks Upon the Difficulty of Creating Payment Models for Oncology
April 22nd 2019

Dr Michael Kolodziej Remarks Upon the Difficulty of Creating Payment Models for Oncology

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.
Voluntary Today, Mandatory Tomorrow: The Value of Early Bundled Payment Participation
April 8th 2019

Voluntary Today, Mandatory Tomorrow: The Value of Early Bundled Payment Participation

Darcie Hurteau
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April 5th 2019

COA Close to Filing OCM 2.0 for Federal Review

Mary Caffrey
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.
Roadmap Launches to Assist Healthcare Stakeholders in Implementing Successful APMs
April 4th 2019

Roadmap Launches to Assist Healthcare Stakeholders in Implementing Successful APMs

Samantha DiGrande
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.
Jessa Dunivan: Cohesiveness Is Vital to Maintaining a Successful Care Management Team
March 27th 2019

Jessa Dunivan: Cohesiveness Is Vital to Maintaining a Successful Care Management Team

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.
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March 27th 2019

Trust Is the Key Ingredient in Medicaid Value-Based Contracts, Manufacturers and Payers Agree

Christina Mattina
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.
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March 22nd 2019

Different Vantage Points, but Similar Goals of High-Value Care, Patient Satisfaction

Laura Joszt, MA
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
Change Healthcare's Annual Survey Points to Challenges for Value-Based Contracts
March 18th 2019

Change Healthcare's Annual Survey Points to Challenges for Value-Based Contracts

Kelly Davio
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.
Jessa Dunivan Explains How the Role of Care Coordinator Has Been Influenced by Value-Based Care
March 15th 2019

Jessa Dunivan Explains How the Role of Care Coordinator Has Been Influenced by Value-Based Care

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.
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March 5th 2019

Effective Population Health Care Delivery Under Medicare’s Merit-based Incentive Payment System: Realigning Accountability With Capability

Adam S. Wilk, PhD Sanjula Jain, PhD
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.
Scott Hewitt Discusses Progress With Bundled Payments
March 1st 2019

Scott Hewitt Discusses Progress With Bundled Payments

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.
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March 1st 2019

ACO Use of Case Mix Index to Comprehensively Evaluate Postacute Care Partners

Mark E. Lewis, MPH Avery M. Day, MPH
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.
Improving Patient-Reported Measurement in Oncology Value-Based Care
March 1st 2019

Improving Patient-Reported Measurement in Oncology Value-Based Care

Allison Inserro
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.
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February 28th 2019

Safety Net Representation in Federal Payment and Care Delivery Reform Initiatives

J. Mac McCullough, PhD, MPH Natasha Coult, MS Michael Genau, MS Ajay Raikhelkar, MS Kailey Love, MBA, MS William Riley, PhD
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.
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