Health Care Cost

As CMS pushes healthcare systems to move away from fee-for-service, the state's largest insurer makes a major move toward value-based payment.

Research has shown that telehealth has the potential for better care at lower costs and with increased convenience, but the issue of paying for this service has yet to be addressed.

A survey of groups using and developing clinical pathways revealed 7 distinct themes that highlight how these pathways are created and used, and the challenges and barriers to creating new pathways, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Although the fee-for-service model of reimbursement has been blamed as an reason for high healthcare costs in America, a report from HealthPocket found that eliminating this payment model in provider-owned health plans did not produce the cheapest health plans.

The basis for determining Medicare payment rates for clinical diagnostic laboratory tests is changing. These changes will be important for all payers and providers to follow for future reimbursement and contract negotiations.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

The pay-for-performance model has come a long way in terms of how physicians are taking care of larger patients populations, according to Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

As personalized medicine rapidly becomes an effective tool for combating cancer, payers are exploring new, value-based payment paradigms. These trends will soon intersect, and depending on how they are structured, the new payment models could accelerate or stifle personalized medicine's progress.

A study attempting to characterize the true preventability of venous thromboembolism determined that financial penalties based on the total number of patients who suffer blood clots in the lung or leg may be unfairly imposed.

CMS' shift to value-based payments has also shifted diabetes care models from cost-centered systems to cost-savings centers, according to Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

On July 27 at 10 am EDT, The American Journal of Managed Care will host a tweetchat with the University of Michigan Center for Value Based Insurance Design to discuss moving from volume to value in healthcare and changing the cost discussion from "how much" to "how well."

As a part of the changing value-based payment model landscape, pay-for-performance programs for medication adherence measures are new for physicians and providers need help understanding the program, explained Mitzi Wasik, PharmD, BCPS.

A new blog post at RAND argues that Medicare's plans to reimburse providers for advance care planning has been a long time coming.

Accountable care organizations can play a key role in building a Culture of Health in which every person in America can have the healthiest life possible.

The challenges in transitioning to value-based payments are rooted in cultural and environmental issues at those institutions that have never truly paid attention to value-based care, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

As CMS continues to transform the Medicare program to a quality- and outcomes-based system, the agency is proposing to support patient- and family-centered care for Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

Despite efforts by states to introduce legislation to make healthcare pricing information more accessible for consumers, most states still receive an F grade, according to the third annual Report Card on State Price Transparency Laws.

Christine K. Cassel, MD, president and CEO of the National Quality Forum, sent her best wishes to The American Journal of Managed Care for its 20th year anniversary in publication.