Interviews

Some exciting developments in value-based insurance design (VBID) have been the introduction of clinically nuanced cost sharing in Medicare Advantage programs, as well as the alignment of demand-side and supply-side payment reform initiatives, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Healthcare providers need to agree on a definition of value, but that discussion must include the voice of the patient, according to Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council. Patient input is especially important when the conversation results in a decision that could affect access to care.

Increasing numbers of physicians are learning of the Choosing Wisely initiative through their specialty societies, said Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation. Awareness has also been boosted by journal articles on the program’s goal of reducing low-value care.

Part of the reluctance to reimburse for telemedicine is that policy makers aren’t aware of the wide range of evidence that currently exists and supports increasing reimbursement for telemedicine, said Kristen McGovern, JD, partner at Sirona Strategies.

The Affordable Care Act has helped reduce uninsurance, but has replaced it with underinsurance. Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School, explains how to address this new problem

Karin VanZant, executive director of Life Services at CareSource, said that social needs are inherently interconnected and by focusing on 1 particular area, the various other factors are bound to be addressed as well.

Individualized medicine can complement the principles of population health to deliver better results for patients, according to Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

Risk adjustment has many variables and cannot always level the playing field between hospitals, 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.

Patient-Centered Oncology Care offers attendees the opportunity to meet and interact with high-level people from various segments of the healthcare industry, explained Scott Gottlieb, MD, resident fellow at the American Enterprise Institute.

When patients develop skin cancers on the nose, Mohs surgeons have to remove the tumor while reconstructing the nose. This surgery heals relatively quickly unless the tumor has grown deeper into the nasal passages, said Ally-Khan B. Somani, MD, PhD, director of Dermatologic Surgery and Cutaneous Oncology at the Indiana University School of Medicine.

Fitbit Group Health focuses on four areas: corporate wellness, research, insurer programs, and health management, said Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

Despite increasing mergers, hospitals can stay competitive in consolidated markets by utilizing tiered or narrow networks, 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.

Physicians develop biases against obese patients due to inadequate education on obesity during medical school, explained Janine V. Kyrillos, MD, FACP, of Thomas Jefferson University Hospitals and the Sidney Kimmel Medical College. She hypothesized that physicians become frustrated with the lack of solutions they have to offer and then shift the blame onto the patients.

Many institutions and researchers responded to the PAN Challenge call for papers last year, and even more are expected this year, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation. He emphasized that this year’s Challenge is especially important because it can help reduce the financial hardships that many cancer patients often face.

Omada Health’s Prevent program has enrolled nearly 55,000 patients since its start in 2012, and has been demonstrating successful, real-world applicable results for patients with pre-diabetes, said Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

As mobile health advances help engage patients as active partners in their healthcare, these technologies can potentially harness that engagement and connect them with interventions, said Leah Sparks, co-founder and CEO of Wildflower Health.

CMS has taken steps to make clinical practice improvement regulations easier for independent practitioners to understand and achieve, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

A patient may be aware of the complications that could arise from a lack of adherence with a chronic disease like diabetes, but education is not enough to change a patient’s lifestyle, explained Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth.

ACOs have great potential in helping achieve a more value-based delivery system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation. She also discussed the challenges that safety net ACOs face in delivering care with fewer resources.

Clinicians may at first be confused by new value-based care regulations, but there are resources to help them understand, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Patricia Salber, MD, MBA, of The Doctor Weighs In, doesn’t believe the healthcare industry will become anything like that of the retail or travel industry, as healthcare is very complicated and consumers may not always be making their own decisions, especially in cases where patients are seeking hospital treatment.

Payment reform in the United States is moving quickly, but there are still a lot of unknowns among providers. Meetings like the ACO & Emerging Healthcare Delivery Coalition help accountable care organizations (ACOs) and providers share best practices and figure out how to succeed, said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and keynote speaker at the ACO Coalition's fall meeting in Philadelphia, Pennsylvania, October 20-21. Learn more about the meeting and register.

Data analytics used to be done in a retrospective manner, and physicians would be looking at the data long after the patient left his or her visit. Now, Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics, explained that her and her team have brought data diagnostics back into the physician’s workflow for easier and faster use.

Mark Lovgren, director of Telehealth Services at Oregon Health and Science University, described how the telementoring program Project ECHO fits into the university’s toolbox of telemedicine programs despite an initial learning curve.

The PAN Challenge is seeking long-term sustainable strategies to expand affordable access to care, which will benefit seriously ill patients the most, according to Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation.

Despite concerns, the use of telehealth visits does not have a significant impact on the overall budget, explained Kristen McGovern, JD, partner at Sirona Strategies. In fact, a recent study found that using telehealth services decreased costs over the long term.

Understanding the population a company serves is important in giving the individual what they want, said Jay Sheehy, senior vice president of product innovation at EmblemHealth. Fact-based information and consumer-oriented solutions are 2 strategies that Sheehy said healthcare companies could deploy to learn more about the consumer and in turn, better engage their customers.