Interviews

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future in 2017 under a Republican Congress and President, but it’s unlikely that the Affordable Care Act will be repealed without some replacement that accommodates the individuals newly covered by it, said Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.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

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.

Many payers are incorporating Fitbit technology into healthcare plans as part of both prevention and clinical treatment programs, hoping that it can help members become healthier and more active, according to Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

What makes Patient-Centered Oncology Care stand out from other meetings is the equal representation among all stakeholders, which gives the meeting a unique depth, said Bruce Feinberg, DO, vice president and chief medical officer at Cardinal Health Specialty Solutions.

Mohs surgery is extremely effective and cost-saving, but it is more difficult when patients have let the tumor grow too large or have had a previous unsuccessful surgery, explained Ally-Khan B. Somani, MD, PhD, director of Dermatologic Surgery and Cutaneous Oncology at the Indiana University School of Medicine.

Reimbursement is not an issue for basic cancer tests, but questions surround the payment and guidelines for more cutting-edge medical innovations, said Bruce Quinn, MD, PhD, a consultant at Foley Hoag. He added that the role of employers in health management is not changing as quickly as we may think.

Because Medicaid programs are so diverse from state to state, expansion may not cause such a radical departure from the current status, says Matt Salo, executive director of the National Association of Medicaid Directors.

Accountable care organizations all over the country have shown that no single method can work for every system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation.

Project ECHO aims to boost provider self-efficacy while lowering costs, explained Mark Lovgren, director of Telehealth Services at Oregon Health and Science University. He hopes the program will expand to cover additional chronic conditions in the future.

Using precision medicine to implement clinical decisions can help healthcare providers achieve the triple aim, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

After CMS released its proposed rule for the Medicare Access and CHIP Reauthorization Act, it received overwhelming feedback from clinicians that spurred the agency to make a number of changes for the final rule, according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Hospital consolidation is a common practice, but its benefits can often be accomplished through other mechanisms, said Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

Health information technology not only gives providers easier access to a patient’s medical history and prior test results in a timely manner, but it allows patients to become more actively engaged in their care, explained Wen Dombrowski, MD, MBA.

During the presidential election, healthcare will be top of mind especially for patients with access issues or significant health issues, Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council. As long as patients feel the healthcare system is engaging them and listening to them, they don't care what it is called.

CMS' decision to pay for the Diabetes Prevention Program marks a shift in payment models from one that originally only paid for the screening and treatment of diabetes to one that now weighs prevention just as seriously in diabetes care, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

As the healthcare system adjusts to the transition to value-based care, providers in particular are having a hard time keeping up with all of the changes, said Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

CMS has a number of mechanisms in place to help physicians successfully adapt to the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA), according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. These efforts include funding practice transformation and quality improvement networks as well as building partnerships with medical societies.

Value-added services are those that improve the patient’s outcome while also being financially efficient, explained Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

Obesity is more than just a lifestyle disease. Ted Kyle, RPh, MBA, principal at ConscienHealth, explained that understanding its complexities as well as the behavioral and physical care it requires is essential in improving the health and productivity of employees.