Value-Based Care

Robert A. Gabbay, MD, PhD, FACP, chief medical officer and senior vice president at Joslin Diabetes Center, said health systems need people with the skill sets that diabetes educators possess to make the transition to a reimbursement system based on quality, prevention, and eliminating costs.

Accountable care organizations (ACOs), either directly or indirectly, are affecting physician employment patterns in regions where they have high penetration.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.

When physicians follow computer alerts embedded in electronic health records, their hospitalized patients experience fewer complications and lower costs, leave the hospital sooner and are less likely to be readmitted, according to a study of inpatient care.

This analysis examines the associations between adherence to Choosing Wisely recommendations embedded into clinical decision support alerts and 4 measures of resource use and quality.

The first in a series of articles that identifies CMS' goals in updating the Medicare Shared Savings Program and how well the proposals make taking on more risk appealing for accountable care organizations.

Following CMS’ announcement of a proposed rule to overhaul the Medicare Shared Savings Program, the National Association of ACOs (NAACOS) released a statement, saying the move will “upend the ACO [accountable care organization] movement by creating havoc with a significant overhaul introducing many untested and troubling policies.”

The share of Medicare Advantage (MA) beneficiaries in the nursing home (NH) population has been steadily rising, while MA plans appear to be increasingly concentrating beneficiaries in select NHs with better performance on quality measures.

Hospital leaders are concerned about how to get ready to take on more risk, said Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health.

Despite the presumption that larger practices that have more resources and are therefore better at providing care and improving outcomes, new research shows that they spend more on and have higher readmission rates for Medicare beneficiaries than smaller practices.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.

We examine utilization, quality, and expenditures among Medicare beneficiaries receiving care at federally qualified health centers and compare outcomes among those attributed to 1 of 3 recognition programs versus none.

The implementation of alternative payment models that successfully capture clinical heterogeneity—without adding unacceptable levels of administrative complexity—may be equally (if not more) important than site-neutral payment policies.

After 5 years of research, the Hutchinson Institute for Cancer Outcomes Research has released a report that is the first in the nation to publicly report clinic-level quality measures linked to cost in oncology.

Experience with risk-based contracting best predicts active engagement of accountable care organizations in reducing low-value medical services, mainly through physician education and encouraging shared decision making.

This article compares clinical and utilization profiles of Medicare patients who are attributed to provider groups with those of patients unattributed to any provider group in accountable care organization models.

CMS Administator Seema Verma said the changes are designed to reduce administrative burdens for physicians so they can spend more time with patients. A group representing community oncologists said a reimbursement change for new drugs could have unintended consequences.

An updated review of value-based insurance design (VBID) as a strategy for increasing consumer adherence to prescription medications found moderate-quality evidence that such strategies are useful for increasing the use of high-value drug classes while lowering cost sharing.

The National Associations of ACOs (NAACOS) submitted comments in response to HHS’ Request for Information on establishing a Healthcare Sector Innovation Investment Workgroup to foster new and innovative approaches to tackle challenges facing the healthcare system.

A national study of 120 payers has found that nearly two-thirds of payments are now based on value, and value-based care is helping stakeholders to achieve the triple aim of lower costs, improved health, and better patient experiences.

At the America’s Health Insurance Plans Institute and Expo, held in San Diego, California, June 20-22, Ezekiel J. Emanuel, MD, of the University of Pennsylvania’s Wharton School and School of Medicine, presented his “prescription for success” for improving healthcare in United States.

Lessons from the first meeting of The American Journal of Managed Care® Population Health Council.

At the Accountable Care Delivery Congress, speakers discussed ways to address social determinants of health, use payment mechanisms as levers, and forge connections through technology.

Palm Beach Accountable Care Organization’s outreach to “dropped patients” demonstrates potential for strengthening physician–patient relationships and lowering the cost of care.

This article reports that an integrated medication management program in a Pioneer Accountable Care Organization was associated with decreases in all-cause hospitalization and Medicare costs.

Physician migration from physician-led practices to hospital employment has shifted. While physicians working for a hospital or in a practice with some ownership increased by 32.6% in 2016, independent and physician led group practices reached 72% in 2017, according to a new Black Book report.

So far, the move to accountable care has been promising, but more needs to be done to encourage providers into risk, said panelists at The American Journal of Managed Care®’s Accountable Care Delivery Congress.

The authors write that these differences among Veterans Affairs (VA) populations could reflect variability across the medical centers in terms of quality of care, adherence to evidence-based treatment and screening guidelines, access to urgent care, posthospitalization care protocols, chronic disease management, and access to specialty care, social work services, and behavioral health care.