Value-Based Care

Wayne J. Katon, MD, professor of psychiatry, director of the division of health services and epidemiology, and vice chair of the department of psychiatry and behavioral sciences at the University of Washington Medical School, says that the type of patient a primary care physician sees can vary depending on the type of insurance the person has.

States did little to improve healthcare access, quality, costs and outcomes in the past five years, according to a Commonwealth Fund report. Researchers examined 42 health indicators between 2007 and 2012, and found that in many states, access and affordability of healthcare actually declined among adults younger than 65. Healthcare spending rose $491 billion, reaching $2.8 trillion nationally.

The American Journal of Managed Care publishes a first-of-its-kind study comparing different types of health insurance plans and different levels of co-payment, to see how varieties of coverage affect access to therapeutic drug classes.

A federally funded effort to identify high-risk patients and coordinate their care is delivering modest savings, but significant cost reductions may come only after broader payment reforms take hold.

As provider reimbursement begins to move toward models that favor quality over quantity, CEO compensation may be following the same path-with CEO pay determined more by quality measures than strictly by financial gains.

Quality-of-care performance means more to CEO paychecks at some for-profit hospital companies than at others.

Healthcare reform has led to a resurgence of interest in various types of population-based management tools, according to David Axene, FSA, FCA, CERA, MAAA, in his presentation Innovations in ACO Partner Risk/Revenue Sharing at the National Association of Managed Care Physicians' Spring Managed Care Forum 2014 in Orlando.

Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for health information technology (HIT), US Department of Health and Human Services, says interoperability is the concept of being able to securely exchange health information, and then appropriately understand and use it.

Neil M. Pressman, FACHE, president, Presscott Associates, discussed a variety of business models for healthcare network management in his presentation at the National Association of Managed Care Physicians' Spring Managed Care Forum 2014 in Orlando.

Providers and insurers alike know that focusing on quality and cost will be essential, especially as healthcare shifts toward accountable care models.

With the delay in ICD-10, many insurers now have to slow down a mammoth IT project and, potentially more disruptive, make adjustments to a whole slew of programs and contracts.

Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.

Lee Newcomer, MD, MHA, of Oncology, Genetics and Women's Health for UnitedHealthcare, says the National Comprehensive Cancer Network is transforming genetic testing by utilizing a tool called the NCCN Biomarkers Compendium, which encourages evidence-based decision-making.

The Obama administration's top Medicare official is stepping down from his post. CMS Principal Deputy Administrator Jonathan Blum has been with the agency for more than five years.

Current healthcare payment systems in the United States are all plagued by the problem of adverse incentivization. A more efficient system would be one which leaves billing entities uncertain of how a given patient encounter will be reimbursed.