Health Care Cost

Precision oncology, or the clinically and financially efficient use of genomically matched treatments and clinical trials, is evolving as a potentially important starting point for cancer care within successful alternative payment models.

The authors apply HHS’s payment taxonomy framework to acute unscheduled care and describe how payment reform supports delivery innovation.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, explained that the 2 gaps that exist in quality measurement currently include data infrastructure and patient engagement.

This week, the top stories in managed care included the release of Medicare's Star ratings for hospital quality, a new proposal from CMS to require bundled payments for cardiac care, and an FDA panel recommended approving a continuous glucose monitoring system for dosing insulin.

To help clinics meet the objectives and reporting requirements of the Oncology Care Model (OCM), Flatiron Health has developed OncoEMR, a cloud-based electronic health record (EHR) coupled with an analytics tool.

Michael Kolodziej, MD, has joined Flatiron Health as national medical director, Managed Care Strategy.

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.