Value-Based Care

This article provides a description of prospective financial simulation methodology and use cases with empirical data for episode-based bundled payments, including implications for contract negotiations and value-based care redesign.

Multidisciplinary care is an ideal way to management non-alcoholic fatty liver disease (NAFLD) because it is a complex disease associated with numerous comorbidities and necessitating lifestyle changes.

Speakers at the Advanced Topics for Oncology Pharmacy Professionals Summit discussed financial toxicity in health care, how it particularly impacts patients with cancer, and how to address the issue with patients and the health system.

Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.

The Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined get back on track and to live up to its promise to incentivize value-based care.

At a session of AHIP 2021 Institute and Expo Online, the head of North Carolina's health and human services department and a health equity policy advisor in the Biden administration discussed how collecting and using data to achieve health equity is ultimately a policy decision.

A report from Xcenda showed that biosimilars for 8 blockbuster reference biologics have successfully kept drug prices from increasing by an average of 56%, restoring the possibility that biosimilars could achieve significant discounts despite facing several barriers to uptake.

One-third of health care in the United States is wasted. Despite this recognition, solutions are sparse. The Optimal Care model combines evidence-based medicine, patient-centered technology, and outcomes reporting to transform health care.

The Medicare Payment Advisory Commission (MedPAC) suggested several changes to Medicare Advantage (MA) plan benchmark calculations, with the intent to generate yield savings for Medicare, and urged CMS to streamline alternative payment model (APMs) where it can.

In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.

This study evaluated cost and utilization attributed to members enrolled in a health care program with no pharmacy co-pay. Health care savings were identified in addition to medication adherence improvements.

Policy makers and health plans seek value-based management of specialty drugs. This study examines real-world factors that favor some approaches over others and their potential impact.

The frequency of low-value care can be reduced by a respectful, data-driven process anchored in nonjudgmental communication and explicit core values.

Although the Center for Medicare and Medicaid Innovation (CMMI) has delayed the start of payment models for kidney care, one dialysis provider says it remains committed to the concept.

The summit will address priority patient inputs for comparative effectiveness research and health technology assessments.

Quantifying the return on investment came up for both those implementing an oncology care pathway (as a potential barrier) as well as for payers still not convinced it is a way to go.

Reducing cascades while maintaining our commitment to high-quality care requires equipping patients and clinicians with the information, tools, and support to embrace uncertainty.

Several barriers continue to impede the transition to value-based payment, particularly administrative and clinical data connectivity, transparency of quality metrics and quality measures, and prioritization of social determinants of health.

A panel of experts provided consumer insights into value-based insurance design (VBID) and how the COVID-19 pandemic may have changed consumer behaviors in a way that VBID may be able to address as the country emerges from the pandemic.

A desire to remove barriers to high-value care and provide services that would improve health and quality of life drove early adopters of value-based insurance design (VBID).

Clinician-, patient-, and research-focused initiatives are needed to reduce the delivery of low-value care services that contribute to financial, clinical, and psychological harm for patients.

A panel of policy experts, including employees of the previous 2 administrations and a former lobbyist for health plans, discusses achievements of value-based insurance design and how to take the concept to the next level.

On this episode of Managed Care Cast, we speak with Sheri Winsper, the senior vice president for quality measurement at the National Quality Forum, to discuss how the forum plans to devise national telehealth quality metrics.

A German-style fair value/pricing committee may be in the works for the United States. However, government payers still have work to do before implementing a value assessment system.