Interviews

Stephen Nuckolls, CEO of Coastal Carolina Quality Care, explained during his presentation at the National Association of Accountable Care Organizations Spring 2016 Conference that the more physicians read and learn about value-based care, the more they are accepting the change. He added that as the idea has become more accepted, ACOs are beginning to evolve as well.

Encouraging the use of generics is only one of the ways to manage the rising costs of medications, according to Karen Ignagni, president and CEO of EmblemHealth. Data and system transparency will also help both the patients and the payers better understand this growing trend.

The work of consumer outreach and enrollment is never done, as Jennifer Sullivan, director of the Best Practices Institute at Enroll America, said that it’s important to partner with community leaders to continue engaging consumers well into the future.

The future of Accountable Care Organizations is very much undefined, as an ACO right now isn’t working to its full potential. However, Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American, is positive that the healthcare system will get there in the coming years.

While there is no limit on the number of patients a physician can prescribe buprenorphine when sought for pain, physicians face governmental limitations on prescribing this medication to patients who need it as treatment for opioid addiction, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine. These restrictions have in turn created several patient access roadblocks to the needed medication.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, believes that while the tone of this year’s presidential election race has been interesting, the discussion among the candidates regarding issues of healthcare and coverage have generally been the same as elections in years past.

Many stakeholders in healthcare have concerns about the same issues just from different vantage points, they just need to be brought together in order to enact any change, explained Linda Schwimmer, JD, president and CEO at the New Jersey Health Care Quality Institute.

Patient adherence is about combining the appropriate tests, lifestyle changes and medications to produce the most optimal health outcomes, said Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth. However, he added that deciding when to pay physicians and patients for adherence and where payment may not be successful is a difficult model to tackle.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, explained that the 2 gaps that exist in quality measurement currently include data infrastructure and patient engagement.

Technology has come to play an important role in the way health plans are interacting with consumers. According to Jay Sheehy, senior vice president of product innovation at EmblemHealth, technology not only gives health plans customized means of communicating with consumers, but it also allows them to better analyze data to tailor messages to each individual.

Patient-reported outcomes are important and necessary measures that should be used more, as they give the patient a voice in terms of the quality of care they receive, said Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum.

The American Enterprise Institute released a report that detailed several proposals of change for the ACA that could possibly be implemented with the next president. Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, said that though these changes would depend on the party in office, implementing them wouldn’t necessarily be easy.

The upcoming election is going to play a large role in the future of Obamacare, which Patricia Salber, MD, MBA, of The Doctor Weighs In, believes will show an increased number of states expanding Medicaid. She added that the ticket will be important in determining the types of legislatures at the state level in the coming years, which in the end determines whether Medicaid will expand in the holdout states.

Recently, there has been more evidence highlighting the importance of social needs interventions, as these measures get to the root of a patient’s specific health issue and can ultimately impact the sustainability of the healthcare system as well as the patient’s quality of life, said Rocco Perla, president of Health Leads.

Communication and education about the available health coverage options was important in keeping consumers informed about enrollment, which Jennifer Sullivan, director of the Best Practices Institute at Enroll America, said was key in engaging consumers.

Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation, discussed innovation happening in healthcare and the growing discussion around social determinants of health and addressing the upstream drivers of health.

Healthcare providers sometimes fail to consider the other aspects of a patient's life that could be affecting physical health and wellness, said Karin VanZant, executive director of Life Services at CareSource.

Stephen Rosenthal, chief operating officer of The Care Management Company at Montefiore Medical Center, said that population health strategies are the future of the health system, where networks would be responsible for the total costs of care for the population they service.

New health technologies will not automatically address disparities-it all depends on how those tools are used, explained Julia Adler-Milstein, PhD, assistant professor at the School of Information and the School of Public Health at the University of Michigan.

The 7 sets of core quality measures from America's Health Insurance Plans (AHIP) and CMS derived from looking at areas that were either high prevalence or high cost, said Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at AHIP.

The value discussion in healthcare is becoming more relevant as the healthcare system increases its focus on better outcomes, said Stephen Grubbs, MD, vice president for clinical affairs at the American Society for Clinical Oncology.

Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum, explained that one’s opinion of quality measures comes from the type of work they are in — while a primary care physician may think there are too many, a health plan could believe there’s not enough. The challenge then, she added, is filling these gaps by creating and testing new, outcome-driven measures.

Specialty pharmacy may be one of the most rapidly rising costs in all of healthcare, but these costs are shouldered by a small percentage of patients. As such, it is essential that new innovative payment models be developed for these new products, said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, said that quality measurement is at the core of transitioning to value-based payment, and that the initiative can’t truly move forward without putting the work in to identify and define what that value is.

Sustainability in the Affordable Care Act marketplaces will occur when the health plans and the providers come together to establish both cost and quality goals and work together to achieve them, explained Karen Ignagni, president and CEO of EmblemHealth.

Although the term "accountable care organization" (ACO) may not be here to stay, value-based organizations are here to stay based on the direction CMS is headed, said Jeb Dunkelberger, vice president of accountable care services at McKesson and clinical & commercial operations at ACO Partner.

There are desirable and undesirable effects of high-deductible health plans, and the use of value-based insurance design may mitigate adverse effects of these plans, explained Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Orphan drugs are a very lucrative business, and Aimee Tharaldson, PharmD, senior clinical consultant of emerging therapies at Express Scripts, expects to see more orphan drugs reach market as manufacturers focus their development efforts in these areas.