Health Care Cost

The report finds a connection between payment reform and hospital use patterns, but that connection may add to the debate that cardiologists have raised over the effect on patients.

Coverage of the 67th Scientific Session of the American College of Cardiology.

In healthcare, the “volume-to-value” movement seeks to align the interests of healthcare providers with the societal triple aim of better care, better health, and lower costs. The devil, as always, is in the details.

Replacing the Merit-based Incentive Payment System (MIPS) with a voluntary program should encourage providers to move quicker into more risk-based payment models, according to Travis Broome, vice president for policy at Aledade.

Curbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.

Adapting payment models to reward outcomes is key to making lifestyle change fit into a managed care framework, several articles find.

Donald M. Berwick, MD, MPP, FRCP, and Patricia Salber, MD, MBA, discuss the idea of a single-payer system and misconceptions about the concept, and what individual states are doing.

Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss payment reform in the healthcare industry, including quality measurements and accountable care organizations.

New Jersey is 1 of 3 states that will test a new set of metrics to assess how well new payment models have penetrated markets, explained Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, which will lead the process in New Jersey.

During the final panel at the fall meeting of the ACO & Emerging Healthcare Delivery Coalition® in Nashville, Tennessee, panelists discussed the progress specialties have made in moving to value-based payment models, as well as the challenges facing the industry as a whole. The panel consisted of 3 individuals who provided perspectives from specific specialties, and 1 with an overall policy perspective.

Most practices are not ready to transition to the Medicare Access and CHIP Reauthorization Act (MACRA) payment models, although there is a leading group of practices that are more prepared to make the switch, said Aaron Lyss, director of value-based care for Tennessee Oncology.

Authors of survey results and a commentary say it's time to focus on recommendations that can bring clinically meaningful change and cost savings.

Participants from 2 oncology community practices—an oncologist–administrator combination—shared their experience with implementing the Oncology Care Model (OCM) with attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

As the healthcare industry tries to move away from fee-for-service, the new Scorecard being developed by Catalyst for Payment Reform will help states get a better understanding of whether or not new payment models are actually working, explained Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute.

Catalyst for Payment Reform will use 3 states to pilot new metrics to measure how well healthcare transformation is penetrating individual markets.

The event will offer presentations on addiction care and payment reform

There are 2 categories of challenges facing oncology practices as they transition to value-based payment models, said Aaron Lyss, director of value-based care for Tennessee Oncology.

Despite the politics involved in healthcare, it seems unlikely that the industry to going to stop its migration toward more accountability for quality, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

As the healthcare industry moves more toward value-based payments, practices have a real need for data that is usable and can help them succeed in new payment models, Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care, explained at OncoCloud '17, held by Flatiron Health September 16-17 in Las Vegas, Nevada.

CMS has issued an informal request for information seeking input on a new direction promoting patient-centered care and market-driven reforms for the CMS Innovation Center.

A recent survey conducted by Integra Connect has found that a majority of specialty physicians have not yet invested in operational changes that may be essential for their success under value-based care reimbursement models.

There are 3 different areas of healthcare that all face different challenges in implementing population health and adopting new reimbursement models, explained Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care articles included a report from the Congressional Budget Office on the impact of eliminating the cost-sharing reduction payments; a decision from CMS to eliminate 2 mandatory bundled payment programs; and a new value-based alliance that called for ending use of a test for diagnosing heart attacks.

There is a lot of evolution happening in healthcare in a number of areas, including policy, technology, and the market, explained Deanne Kasim, founding partner of Santesys Solutions.

This meeting presents unique perspectives on emerging topics in managed care from today’s leading experts

At the 2017 American Society of Clinical Oncology Annual Meeting, oncologists heard from fellow experts on the best way to navigate the daunting challenge of payment reform.

The survey found a jump in physician burnout since 2013 and a gap in the commitment to combat medical errors, a problem that persists despite the movement toward quality measures.

Public and private payment reforms such as accountable care organization contracts have shown some initial evidence of changes in physician behavior, but their full promise remains to be seen, according to Zirui Song, MD, PhD, resident at Massachusetts General Hospital.