Interviews

CMS must learn from implementation of new quality measure sets as it refines and expands the Core Quality Measure Collaborative, Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

The general public and policy makers still still view obesity as a personal failing, which explains why there has been a lack of progress to develop policies for obesity treatment, said Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital.

Implementing precision medicine is a complex undertaking that cannot be accomplished without the use of health IT tools, according to Jonathan Hirsch, founder and president of Syapse. He identified the 4 key functions of healthcare IT that allow Syapse to expand access to precision medicine.

The Delaware Valley Accountable Care Organization (ACO) was disappointed to learn that under CMS’ Medicare Access and CHIP Reauthorization Act (MACRA) final rule, the practice would not be categorized as an advanced alternative payment model (APM) and would likely have less of an upside under the Merit-based Incentive Payment System (MIPS), said Katherine Schneider, MD, president of the Delaware Valley ACO. However, Dr Schneider said she understands CMS’ point of view and why it needed to make changes to the final rule.

Barry Russo, CEO of The Center for Cancer & Blood Disorders, said that his practice continues to collect quality and claims data from a number of sources, even though it isn’t easy. Russo also said that payers are not particularly interested in participating in a value framework, instead choosing to focus on the oncology care model (OCM).

After realizing that improving care for the sickest, most expensive patients is crucial to a high-performing healthcare system, 5 philanthropic organizations joined forces to create “The Playbook: Better Care for People With Complex Needs,” said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

As Medicaid shifts toward value-based payments, it needs to transform the delivery and payment systems to reward positive outcomes, said Matt Salo, executive director of the National Association of Medicaid Directors.

Innovative funding models like value-based payments can change providers’ incentives and drive them to seek solutions like palliative care, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

Relationships with accountable care organizations and provider organizations can help payers join in a value-based, holistic approach to improving health within a community, said Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

Fitbit is more than just a fitness tracker; it’s a social experience that engages people and keeps them motivated, said Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

Bundled payments are an interesting experiment, but they should have more clinically relevant time periods and include more quality measures, said Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Mental health treatment is a necessary prerequisite for effective treatment of the patient’s medical conditions, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

Immuno-oncology will be an important part of cancer care in the future, but probably not the only part, predicted Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network. He also explained how patient advocacy and an enduring healthcare system are essential to the advancement of cancer care.

In an increasingly tech-focused world, the use of phones, tablets, and computes, combined with social media sites, have allowed patients to find the emotional and social interactions they need when dealing with their care, said Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

Cancer patients can now receive individually personalized treatment thanks to algorithms that account for their own unique factors, according to Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

Access to dermatology care is limited around the world, especially in remote areas, but the Veterans Affairs' teledermatology program aims to improve both access to and quality of dermatological care, said Nellie Konnikov, MD, professor and chief of dermatology at the Boston Department of Veterans Affairs.

Stabilizing and treating mental illnesses reduces the cost of treating associated medical problems, leading to a win-win situation, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

Payers and providers continue to make progress towards implementing value-based reimbursement, and while there is still work left to be done, experts are optimistic about a path to maturity, according to Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives.

Oncology is a perfect fit for the bundled payment model, because it evaluates the outcomes, patient satisfaction, and cost of an oncology episode, said Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ. She said that Horizon adopted the bundled payment model early to cope with New Jersey’s rising healthcare costs.

Accounting for socioeconomic status in risk adjustment can avoid penalizing hospitals with more low-income patients, according to Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Wen Dombrowski, MD, MBA, Resonate Health LLC, said that it’s important to develop health information technologies because the lack thereof not only impacts the individual living with the condition, but the entire environment and community he or she may live in.

The general stigma and bias circulating obesity hinders the ability to improve the patient’s health, explained Ted Kyle, RPh, MBA, principal at ConscienHealth. With number of individuals with obesity, patients, physicians, and payers can’t afford to think of obesity as a purely cosmetic condition.

There is significant uncertainty surrounding the healthcare system’s future in 2017 under a Republican Congress and President, but it’s unlikely that the Affordable Care Act will be repealed without some replacement that accommodates the individuals newly covered by it, said Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.

When helping cancer patients decide if immuno-oncology treatments are right for them, clinicians should not focus only on the potential risks and benefits, said Debra L. Madden, cancer research advocate and patient representative. Oncologists should ensure patients are aware of the variable responses to the therapy, like the phenomenon of pseudoprogression.

The transition to value-based care allows clinicians to focus on a few common areas instead of multiple measures for different payers, explained Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Mobile health apps are a valuable source of data that could lead to new clinical and intervention insights, according to Leah Sparks, co-founder and CEO of Wildflower Health. However, she said, users must first overcome their fear of the unknown.

Value-based care in oncology will be a great thing for patients because it will bring the caregivers together, said Roy Beveridge, MD, chief medical officer of Humana and the keynote speaker at Patient-Centered Oncology Care.

Clinicians can sometimes focus only on a patient’s medical needs, but listening to the patient’s own goals and priorities often reveals social drivers of health that must be addressed, said Renee Murray, associate clinical director of Care Management Initiatives at Camden Coalition.