Policy

Patient-centered medical homes are valuable because they allow insurers to look at the cost of all of the patient’s treatments, services, and physicians throughout the continuum of care, explained Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ.

A study published last October indicated that hospitalist groups with a higher ratio of physician assistants to physicians achieved the same outcomes at lower cost in a community hospital setting. Lead author Timothy Capstack, MD, explained to The American Journal of Managed Care® how these hospitalist models can benefit patients in a variety of healthcare settings.

Underinsurance, which occurs when people have insurance but aren't covered for services they need, is a serious problem in the US, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan. He proposed some strategies to alleviate this phenomenon, like smarter deductibles and revised Internal Revenue Service (IRS) rules.

For cost-effective cures, the drug pricing policy challenge is not simply to lower prices, but also to spread the drug costs among payers.

Bundled payment models could provide surgeons with a full spectrum of data that can help them decide which hospital is the right choice for their patients, said Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives. He also said that this data can drive improvement for hospitals that may be falling behind.

Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.

Shortly after Cigna announced it would stop covering the name-brand EpiPen, CVS declared it would begin selling a cheaper generic version of the costly epinephrine injector. Earlier in the week, Heather Bresch, CEO of EpiPen manufacturer Mylan, had reflected on the controversy surrounding the device’s price.

Payments for catastrophic coverage under Medicare Part D have more than tripled since 2010, rising past $33 billion in 2015, according to a new report from the Office of Inspector General (OIG). The report identified high-priced specialty drugs as a major driver of the increase in spending.

While rapid innovations in the field of oncology have improved treatments, the magnitude and dimension of clinical benefits vary widely.

Cancer care and its associated costs can combine with everyday bills to create a significant financial burden, especially for young adults with cancer, said Samantha Watson, founder and CEO of The Samfund.

The kind of data oncologists need to move towards value-based care isn’t easily accessible in patient electronic health records, but new platforms like Cancer Outcomes Tracking and Analysis (COTA) are trying to make it easier, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Among Michigan primary care practices, sustained participation in a pay-for-value program appears to contribute to improved utilization outcomes for high-need patients.

This year, the most read articles from The American Journal of Accountable Care® explored how healthcare providers and payers have implemented innovative ideas to reduce spending while maintaining or increasing the quality of care.

A case study of an innovative model for wound care suggested that an integrated approach to healing wounds could result in decreased costs of care and length of hospital stay.

A recent study that conducted interviews with mainly Latino residents of agricultural communities in California found that most considered affordability, not access, a major barrier to buying healthy foods.

The new era of data informatics tools can help providers and payers understand the tiers of risk that determine the economics of care delivery, which is crucial to value-based cancer treatment, according to Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology

What we’re reading, December 16, 2016: consumers now have until December 19 to enroll in a marketplace plan for coverage starting on January 1; 20 states file lawsuit against 6 pharmaceutical companies alleging generic price fixing; women who were tested for the BRCA mutation gene after Angelina Jolie’s announcement may not have been at high risk to begin with.

The authors illustrate a methodology for delineating variations in medical costs for patients with similar clinical conditions and needs using electronic health record data.

As the healthcare industry continues its transition toward value-based care, some medical ethicists have raised concerns about how education with an emphasis on value can potentially conflict with patients’ best interests. An opinion letter published in JAMA discusses various strategies for addressing these tensions.

An analysis of per capita Medicare spending among beneficiaries with 6 or more chronic conditions reveals wide geographic variations in costs across the US, with similar spending levels often seen in counties neighboring one another.

The amount of Americans under age 65 in families having trouble paying medical bills has dropped significantly over the past 5 years, according to a survey report from the National Center for Health Statistics. The percentage of children in families that struggle to pay healthcare bills has steadily declined as well, though as of June 2016 it remained higher than the percentage of such adults.

Oncology is a perfect fit for the bundled payment model, because it evaluates the outcomes, patient satisfaction, and cost of an oncology episode, said Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ. She said that Horizon adopted the bundled payment model early to cope with New Jersey’s rising healthcare costs.

A review of our peer-reviewed research in the healthcare and mainstream press.

This paper presents a policy proposal to integrate care for Medicare beneficiaries through creation of integrated care organizations and a Medicare home care benefit.

Using precision medicine to implement clinical decisions can help healthcare providers achieve the triple aim, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

After CMS released its proposed rule for the Medicare Access and CHIP Reauthorization Act, it received overwhelming feedback from clinicians that spurred the agency to make a number of changes for the final rule, according to Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Hospital consolidation is a common practice, but its benefits can often be accomplished through other mechanisms, said Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

As the healthcare industry continues its transition towards alternative payment models (APMs), some providers might feel apprehensive about keeping up with new requirements like those in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. However, these providers can use healthcare information technology (IT), data analysis tools, and other resources to adapt to these changes, according to Suzanne Travis, vice president of regulatory strategy at McKesson.

Among the measures on the ballot for Californians this Election Day is Proposition 61, the Drug Price Standards Initiative. The measure, which would restrict the amount state agencies pay for drugs, has a multitude of supporters and opponents who have amassed a combined $125.84 million in contributions as of Monday.

Medicaid programs provide hepatitis C treatments to needy patients despite the high price, said Matt Salo, executive director of the National Association of Medicaid Directors. He is optimistic that having more manufacturers in the market will bring costs down and make treatment more accessible for all.