CMS' star ratings for hospitals have been controversial because they penalize hospitals that disproportionately care for the poor and the sick, and efforts by CMS to adjust the methodology haven't really addressed the concerns, explained 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.
Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.
The integration of data analytics into everyday use has allowed physicians to better engage in the patients care by intervening and taking action early, which ultimately improves quality of life and outcomes, said Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.
While Omada Health’s Prevent program is designed for individuals with prediabetes, it can be adapted to patients who already have diabetes, because the program is built on behavior change and modification, explained Mike Payne, MBA, MSci, former chief healthcare development officer at Omada Health.
The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.
The commonly held perception of obesity as a personal failing on the part of the patient is outdated and unhelpful, said Janine V. Kyrillos, MD, FACP, of Thomas Jefferson University Hospitals and the Sidney Kimmel Medical College.
Ideally, the healthcare industry needs to be more consumer driven, so that solutions and programs are built with the patient in mind, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.
Since the implementation of the Affordable Care Act, more and more individuals are gaining access to insurance. Therefore, part of the New Jersey Health Care Quality Institute's responsibility is to make the complexities of the healthcare industry more easily understandable for members, according to Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute
Patricia Salber, MD, MBA, of The Doctor Weighs In, said that geographic location is one of the largest disparities impacting healthcare today, for it affects not only the types of plans available to individuals based upon where they live, but it also has an impact on the actual health outcomes of communities across the nation.
Different value frameworks offer different things, as Alan Balch, PhD, CEO of the Patient Advocate Foundation, explained that each framework has various other objectives in mind. Balch differentiates frameworks based upon whether their objectives reach individual or population-based levels.
Academic work has the potential to demonstrate positive outcomes for patients, but practically speaking, Lonny Reisman, MD, CEO of HealthReveal, said physicians simply don’t have the time to read, comprehend and apply the data when they are seeing and treating patients continuously all day.
Project ECHO works as a telementoring program with a team of specialists consulting with primary care physicians and sharing their knowledge, explained Mark Lovgren, director of Telehealth Services at Oregon Health and Science University.
As leader of the Robert Wood Johnson Foundation, Risa Lavizzo-Mourey, MD, MBA, has worked to advance the Culture of Health, a vision in which everyone in America can live longer, healthier lives.
Large insurers reducing their involvement in the Affordable Care Act health insurance exchanges doesn't necessarily indicate failure, but success is not guaranteed, said Michael E. Chernew, PhD.
Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth, explained that paying patients for adherence could be efficient when the payment initiatives are targeted towards members who have not shown to be adherent; however, he added that there are several limitations in paying for adherence, including the sustainability of the system and whether it will incentivize patients who are adherent to stop taking their medications.
CareSrouce’s Life Services program is a voluntary program in which individuals can decide on their own whether they would like to participate, a feature that Karin VanZant, executive director of Life Services at CareSource, said is especially appealing to their members.
The use of on-demand data in the healthcare setting has gone through an evolution from the beginning, which was about pulling information into 1 pool and then understanding how to analyze it. The next step in this process is integrating this technology into the workflow of physicians and using the information in a real time and impactful way, according to Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.
Remote patient monitoring is one of the most exciting innovations in diabetes care, as it allows both the patient and the physician access to real-time data that wouldn’t have been accessible in the past when patients only went to see their doctor once every couple of months, said Kristen McGovern, JD, partner at Sirona Strategies.
Payment reform's impact on socioeconomic disparities may not matter if the growth in healthcare expenditures in the United States means the government or payers can’t afford to pay for the medicines, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.
While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that care coordinators have played an important role in his ACO to reach out to the patient and motivate them to become more engaged in their care. What makes a difference is showing the patient how much you care, he added.
Performance measurement is at the heart of improving healthcare, and part of this transition to value-based payment means creating measures that track the improvements of quality care, said Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum.
Ted Kyle, RPh, MBA, principal at ConscienHealth, explained that in order to prevent diabetes, a patient’s health-related risks needs to be addressed, and part of these risks stem from obesity. He added that a program like Medicare’s diabetes prevention program is exactly the tool the curb this progression.
Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), explains some of the biggest transitions she faced in moving from the public sector of working with HHS to the private sector of now working with AHIP.
Rethinking the ways in which hospitals get reimbursed and removing barriers to patient centered care are just 2 ways in which hospitals can consider moving from volume to value, said Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System.
Jay Sheehy, senior vice president of product innovation at EmblemHealth, explained that improving customer experience is important in engaging the individuals, which can only be done if the health plan thinks more like a consumer and less like a healthcare company. Research and analysis as well as figuring out what is most important to the consumer is critical in engaging patients with their care.
While the implementation of the ACA helped to manage healthcare costs in the beginning, Patricia Salber, MD, MBA, of The Doctor Weighs In, said that there are just certain factors that will always make dealing with growing costs very difficult.
Not only are patients with prediabetes benefiting from Omada Health’s Prevent program, Omada benefits as well by learning from the enrolled patients about how to better serve the Medicaid population, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.
Rocco Perla, president of Health Leads, explained that not only do stakeholders in the health system need to come together, but that the conversation also must be patient-centered to truly make headway in care reform.
In a series of video interviews, Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement, discussed the lessons learned from the Aligning Forces for Quality initiative.
Digital technology has great potential to improve the communication between providers and members, said Albert Tzeel, MD, MHSA, FAAPL, regional medical director of senior products at Humana. However, there are also drawbacks that come alongside digital technology that Dr Tzeel said is worth considering.
