Health Care Cost

A study of readmission rates by primary care providers (PCPs) finds a lack of variation and calls into question implementing pay-for-performance programs that incentivize or penalize PCPs for readmissions.

Humana has expanded its focus to the social determinants of health because issues like food insecurity and lack of transportation impact outcomes even if patients are getting the best medical care, said Bryan Loy, MD, physician lead, oncology, laboratory, and personalized medicine, Humana.

Even though Northwestern Medicine is projected to sustain a loss in the new Bundled Payments for Care Improvement Advanced, it plans to participate because doing so will position Northwestern Medicine as best possible to manage future challenges in episodes of care.

The advantage of having mandatory models is it enables you to get participation broadly across the community and it allows you to design the bundle in a way that’s not so intent on encouraging participation. If you have voluntary participation you are somewhat limited as to how you could design the bundle, because if you design it too aggressively no one will participate, explained Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy; director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School; and co-editor-in-chief of The American Journal of Managed Care®.

Some of the health policies coming out of Washington, DC, are clever, but there might be too much coming out for practices to keep up with, said Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

Payers, providers, and other stakeholders have to come together to figure out how to make a better patient member experience for those who are fighting cancer, said Bryan Loy, MD, physician lead, oncology, laboratory, and personalized medicine, Humana.

The new primary care models from HHS will provide greater flexibility to practices that want to participate and deliver care in a different way to reduce hospitalizations, said Travis Broome, vice president of policy at Aledade.

Creating a value-based care system means upending the current one and providing more models to encourage providers to take on risk.

Implementing new payment models is really complicated, and the private sector is not doing as much as the public sector, said Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.