Health Care Cost

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.

An initiative that provided Pennsylvania Medicaid patients with a primary care “medical home” reduced the costs of their care by up to $4100 per year and decreased the number of their physician visits and hospitalizations.

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.

While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that fair and transparent benchmarks are important in creating successful ACO programs.