Alternative Payment Models

A new study found hospital participation in 5 common medical bundles under the Bundled Payments for Care Improvement initiative was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality.

Payment reforms efforts are still facing barriers, but buy-in and increased demand from self-insured employers can help spur widespread adoption of new payment models that will lead to health delivery system reforms, according to a commentary published in New England Journal of Medicine.

When the CMS released performance reports for the 181 practices enrolled in the Oncology Care Model (OCM) earlier this year, the action had the effect of creating as much confusion as it resolved.

With the evaluation period for the Oncology Care Model at its midway point, there is an opportunity to discuss how the program and other bundled payment programs can better deliver on aims to provide higher quality care at the same or lower cost.

As value-based pricing gains traction in the US healthcare market, "distinctions in both method and likelihood of improving aligning prices with value should be carefully considered," write authors in JAMA.

Health plans continue to show interest in expanding outcomes-based contracts, according to an Avalere Health study that also found cardiovascular diseases, infectious diseases, and oncology represent the most common therapeutic areas to have these contracts.

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, is taking on an additional role as the senior advisor for value-based transformation and innovation. He represents the last departmental appointment as part of HHS Secretary Alex Azar's 4 priority areas.

The implementation of alternative payment models that successfully capture clinical heterogeneity—without adding unacceptable levels of administrative complexity—may be equally (if not more) important than site-neutral payment policies.

After 5 years of research, the Hutchinson Institute for Cancer Outcomes Research has released a report that is the first in the nation to publicly report clinic-level quality measures linked to cost in oncology.

Experience with risk-based contracting best predicts active engagement of accountable care organizations in reducing low-value medical services, mainly through physician education and encouraging shared decision making.

The shift to value-based care has stalled since 2017, according to a survey of health plan executive and providers commissioned by Quest Diagnostics. Quest said its third annual study suggests that physicians need better tools, like data access, and less complex quality measures to spur adoption of value-based healthcare, which focuses on care quality and patient outcomes rather than the quantity of services delivered.

Quality measurement has been around for nearly 2 decades and in that time measures have evolved and also proliferated to the point of placing considerable burden on physicians and health systems. New efforts are being made to streamline current measures, fill in gaps, and harmonize measures across programs.

This article compares clinical and utilization profiles of Medicare patients who are attributed to provider groups with those of patients unattributed to any provider group in accountable care organization models.

A study found that hospitals participating in Medicare’s Bundled Payments for Care Improvement and hospitals not participating are dissimilar in meaningful ways that limit the generalizability of the program's results.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included additional moves by the Trump administration to unravel the Affordable Care Act; Pfizer canceled a round of drug price increases after speaking to the president; advocates for 340B sound the alarm on efforts to reform the program.

While small and rural practices will likely perform better in the Merit-based Incentive Payment System (MIPS) than they have in previous programs, they will still be outpaced by larger practices. Stakeholders also outlined challenges they think will likely continue for these practices under MIPS.

Experts at the National Comprehensive Cancer Network Policy Summit discussed the present challenges of transitioning to alternative payment models at a time when the costs of many cancer therapies are rising.

Experts recently proposed 3 steps to promote targeted cancer drugs that yield clinical benefits while reducing overall price growth.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action.

In the United States, too many of our mothers are dying during and after childbirth. Costs of childbirth care are high for everyone—for health plans, for taxpayers, and for families. We are moving in the wrong direction, and it is well past time to change course.

Although most practices participating in CMS' Oncology Care Model (OCM) are among the most sophisticated in the country, they've run into challenges and have identified areas for adjustment in the 5-year pilot.

CMS is launching a demonstration of its Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI), which pushes Medicare Advantage (MA) providers into taking on more risk. The demonstration, which has to be approved and adopted, would waive Merit-based Incentive Payment System (MIPS) requirements for doctors opting into the new program.

With the American population aging, the healthcare system will need to undergo a transformation, HHS Secretary Alex Azar said when he spoke before the Health Care Association/National Center for Assisted Living.