Health Care Cost

There is a need for a new stop loss formula that ensures a level playing field and motivates accountable care organizations.

This week, the top managed care stories include Humana announcing executive bonuses are now partially tied to value, Veterans Affairs has expanded access of hepatitis C drugs to all veterans in the system, and CDC releases guidelines on prescribing opioids.

As the industry continues its move to value-based care, health plans need to build trusted relationship for the move to be successful, according to Charles Fazio, MD, MS, medical director of HealthPartners, Inc.

The 42nd annual meeting of the Association of Community Cancer Centers ensured that none of the oncology care providers in the audience left without realizing that healthcare has slowly been migrating to include value in care delivery and reimbursement decisions.

At the end of February, Ted Okon, MBA, executive director of the Community Oncology Alliance (COA), answered questions on Twitter about the latest trends in cancer care and discussed COA’s concerns with the president’s moonshot initiative and the 340B drug pricing program.

A new report published by the American Society of Clinical Oncology has drawn a mixed picture of oncology care in the United States-reduced mortality, increased survivors, and progress in treatment coupled with unsustainable costs and an unstable clinical setting.

Although health plan accountable care models have evolved provider readiness, data, analytics, and the use of performance measurement are important components of plan-provider partnerships.

The newly proposed Medicare Part B payment demonstration met immediate criticism from some in the healthcare industry. Chip Kahn, president and CEO of the Federation of American Hospitals, is also very hesitant about the demonstration and worries that it might be premature.

Public and private payers all heading in the same direction in regards to payment reform is sending a consistent message to providers and creating alignment in healthcare, said Stephen Ondra, MD, senior vice president and enterprise chief medical officer at Health Care Service Corporation.

The average cost per episode dropped $6708 from the first year of the pilot to the third year.

The implementation of a reference-based payments program by the California Public Employee's Retirement System reduced payments for colonoscopies by $7 million over 2 years.

Oncologists now face a cost discussion that was not part of their medical training. It's a balancing act between the big picture of understanding the burdens on the system and "the patient in front of you."