Value-Based Care

For 2 successive years, the Hackensack Alliance Accountable Care Organization achieved cost savings and maintained quality by using physicians with patient-centered medical homes and nurse care coordinators focused on high-risk patients.

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.

Recently, McKesson Business Performance Services and Blue Cross Blue Shield of Arizona partnered to form ACO Partner, a shared savings program focused on improving outcomes and costs.

Many large, well-integrated medical groups with infrastructure to manage care effectively continue to receive a majority of revenue from fee-for-service and pay physicians based on productivity.

Scottsdale Health Partners helps patients with social needs through a complex care coordination program and working with community resources like adult protective services or other city government branches, James Whitfill, MD, chief medical officer, explained at the National Association of ACOs Spring 2016 Conference.

Poster presentations at the American Diabetes Association Scientific Sessions compared canagliflozin, an SGLT2 inhibitor, to sitagliptin, a popular DPP-4 inhibitor, using claims data.

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.

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.

High costs associated with specialty pharmacy will necessitate the evolution of a new specialized model to help ensure that patients are receiving the financial assistance they need and adhering to their treatment, according to Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

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.

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.

At the spring live meeting of the ACO & Emerging Healthcare Delivery Coalition in Scottsdale, Arizona, attendees heard presentations and participated in workshops that discussed better integration of care, improved use of technology, and the future of healthcare and the Affordable Care Act.

Accountable care organizations can improve outcomes and patient experience while reducing costs through integrated care and better use of technology.

Scottsdale Health Partners’ success is derived from its physician engagement, care coordination and transformation, and meaningful IT usage, explained James Whitfill, MD, chief medical officer. The organization has also learned that direct contact with both patients and provider is critical to continuing that success.

As healthcare moves to value-based arrangements and delivery models like accountable care organizations (ACOs), the benefit of incorporating a pharmacist can be overlooked. Tina Joseph, PharmD, BCACP, and Reena Jones, PharmD, CPh, both from Nova Southeastern University, outlined how pharmacists can be integrated into ACOs in order to improve care and patient satisfaction, while reducing cost.

The National Quality Forum’s Measure Applications Partnership recently released guidelines on measures for the new Merit-Based Incentive Payment System and on cross-cutting issues for all federal healthcare programs.

If accountable care organizations (ACOs) are going to be successful, they need to learn from another and have meetings like the ACO & Emerging Healthcare Delivery Coalition's Spring Live Meeting, being held April 28-29 in Scottsdale, Arizona, to exchange good information, explained Michael Chernew, PhD, co-editor-in-chief of The American Journal of Managed Care. Dr Chernew will also sit on a panel discussion about the future state of healthcare in the United States during the ACO Coalition's meeting.

One of the greatest challenges for the healthcare industry as it moves to value-based payments is shifting from a short-term to a long-term mode of thinking, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.

The top stories in managed care include a recap of Patient-Centered Diabetes Care, the case for the Oncology Medical Home, UnitedHealth leaves Affordable Care Act exchanges in 2 states, and CMS expands alternative payment model for primary care.

In 2012, electronic health record use and participation in accountable care organization or patient-centered medical home initiatives were associated with performing care processes expected to improve healthcare outcomes.

Everyone in healthcare is currently grappling with what payment reform will look like in the coming years, and oncology is no exception. Payers, providers, and health policy experts reviewed ongoing changes in the healthcare system and shared their vision on what the future would look like.

In preparation for the Spring Live Meeting of the ACO & Emerging Healthcare Delivery Coalition, 2 speakers who will be at the meeting will participate in 2 30-minute tweetchats.

This week in managed care, the top stories included new data on statin prescriptions, a trial found the PCSK9 inhibitor Repatha successfully lowered cholesterol, but an editorial said the price might be too high to be worth it, and Farzad Mostashari, MD, discussed care transformation.

It looks like 2016 is shaping up to be the most pivotal year in healthcare policy in a long time.

There is a need for a new stop loss formula that ensures a level playing field and motivates accountable care organizations.