Interviews

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.

Programs that care for complex patients lack a sustainable source of funding that provides structural flexibility, according to Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers. He also mentioned that there had been no gatherings solely dedicated to caring for the most complex patients until The National Center for Complex Health and Social Needs’ Putting Care at the Center conference.

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.

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.

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.