Health Care Cost

A report developed by Avalere Health, based on a survey that the company conducted among health plans in 2015, states that a majority of health plans want to sign outcomes-based contracts with biopharmaceutical companies, especially for oncology and hepatitis C drugs.

At The Community Oncology Conference: Innovation in Cancer Care, oncologists discussed how their practices are coping with the transition toward quality- and value-based reimbursement.

An expert panel at The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, provided insight on current transitions in healthcare reform, and their predictions for the future.

CMS has developed the Oncology Care Model (OCM) to provide physician practices that furnish chemotherapy treatment the option of payment arrangements that include financial and performance accountability for episodes of care for cancer patients. This article presents an overview of the model and guidelines that can help meet the quality and performance measures for OCM participation.

Karen Ignagni discusses taking over EmblemHealth and implementing a turnaround after the company experienced net losses of more than $485 million in 2014, as well as the healthcare industry's transition to value-based payment.

The top managed care stories this week included an update to the American Society of Clinical Oncology's value framework, a study that reported readmission rates among safety net hospitals after cancer surgery, and findings that bariatric surgery can benefit patients with diabetes.

The new accountable care organization (ACO) benchmarking rule changes it so ACOs aren't just competing against themselves and transitions so ACOs have to be better than others in their region, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.

In order to slow the rising costs of prescription drugs there has to be a greater emphasis on value-based payments, on transparency, and on the consumer, perhaps even with the government’s help, said John Bennett, MD, FACC, FACP, president and CEO of CDPHP.

As the most advanced accountable care organization (ACO) model, Next Generation ACO has its appeal. However, it is the riskiest model, and one ACO explains why it decided to stay with the Medicare Shared Savings Program.

What we're reading, May 27, 2016: treatment for pregnant women is often based on guesswork since few drugs are ever tested on them; a new superbug in the US is resistant to even the antibiotic of last resort; and how small physician practices can adapt to new payment models.

Accountable care organizations have to work more on engaging physicians in meaningful leadership roles and should focus on learning about patient goals, said James Whitfill, MD, chief medical officer of Scottsdale Health Partners.

Measuring the quality of oncology care and associating it with reimbursement, and high drug prices remain important concerns of value-based outpatient cancer care. A healthcare economist reviews the current status and suggests a potential path forward.

In order for accountable care organizations to overcome short-term thinking they must be careful with their fee-for-service codes and ensure that people are using the system responsibly, Farzad Mostashari, MD, chief executive officer of Aledade, said at the National Association of ACOs Spring 2016 Conference.

The Medicare Part B demonstration has been controversial since its announcement, but Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review, considers it a wise move on the part of CMS because it provides an opportunity to learn about different payment structures.