Value-Based Care

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 changes to the Next Generation ACO Model caused 7 accountable care organizations to leave the model; a report highlights how quickly hospital acqusition of physician practices is occurring; CMS finalizes coverage for Next-Generation Sequencing tests.

Patients with acute myeloid leukemia (AML) who were treated at a National Cancer Institute-designated cancer center had a 53% lower risk of early mortality, according to a study published in Cancer.

Panelists Kavita Patel, MD, Brookings Institute; Michael E. Chernew, PhD, Harvard Medical School; and Katy Spangler, Spangler Strategies discussed implementing the value-based insurance design concept in health policy and payment models, challenges with quality measurements, the role of employers in value-based care, and more at the VBID Summit, held March 14 by the University of Michigan Center for Value-Based Insurance Design.

At the Association of Community Cancer Center’s 44th Annual Meeting & Cancer Center Business Summit, March 14-16, 2018, in Washington, DC, payer and physician representatives shared the stage with the president of a cancer foundation that is striving to break the barriers that prevent easy healthcare information exchange and access to cancer care.

Overview of alternative payment models and how leading national organizations are involved with linking quality improvement initiatives and payment reform.

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

This study examined patient clinical and demographic characteristics, healthcare system factors, and patients’ experiences of care associated with 30-day readmissions in a hospital with a Pioneer Accountable Care Organization.

A discussion of chronic pain prevalence, care obstacles, and potential opportunities for care improvement within the accountable care organization context at University of California, San Francisco Health.

Positive quality interventions are part of a nationwide effort to standardize and improve oncology dispensing practices. They are best practices that are meant to be highly specific to a drug and help pharmacies and clinicians ensure that a patient-centric model exists, explained speakers during a workshop at National Community Oncology Dispensing Association (NCODA) Spring Forum 2018.

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

In a joint letter, several organizations urged CMS Administrator Seema Verma to allow certain accountable care organizations to continue in the Medicare Shared Savings Program (MSSP) Track 1 for a third agreement period, warning that these ACOs are not ready to take on a 2-sided risk.

Aledade and Horizon Blue Cross and Blue Shield of New Jersey partner to help practices take advantage of payment models that reward physicians who offer better quality care while lowering costs.

On Friday, a bipartisan group of governors unveiled a blueprint to reform the US health system in an effort to produce better health outcomes at a lower cost to governments, employers, and individuals. The plan focuses on aligning consumer and provider incentives, encouraging more competition and innovation, reforming insurance markets, expanding proven Medicaid innovations, and modernizing the state–federal relationsip.

Coverage of digital technology updates from Patient-Centered Oncology Care, November 16-17, 2017.

Patient-reported outcomes can be critically important, said Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.

A symposium at Seton Hall Law School examined the role of care coordination and transitions in helping those with substance use disorder find success in treatment. Some experts say that managed care has not supported care coodination despite evidence that it works and ultimately saves money for health systems.

A new National Bureau of Economic Research working paper identified potential hospital cost shifting and that hospitals penalized by the Hospital Readmission Reduction Program and the Hospital Value-Based Purchasing Program actually had an increase in average payments of 1.5%.

We developed short patient experience surveys that were sensitive to our broad quality initiative, were meaningful and acceptable to patients, and had good response rates.

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

From 2013 to 2016, Medicare Shared Savings Program accountable care organizations (ACOs) improved quality. Continued infrastructure development funding, better relationships with postacute care facilities, and shared learnings among diverse ACOs would maximize quality improvement.

From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.

In healthcare, the “volume-to-value” movement seeks to align the interests of healthcare providers with the societal triple aim of better care, better health, and lower costs. The devil, as always, is in the details.

The benefits and challenges of joining CMS' Virtual Group option for healthcare providers to report their Quality Payment Program (QPP) measures from 2018.

Shifting care for patients with chronic obstructive pulmonary disease (COPD) from the hospital to the home reduced hospital readmissions by 64% and emergency department visits by 52%, a Canadian program found.

Over the next years, these spheres (ACOs, primary care, and oncology) that are going on in CMMI need to be coalesced together so that when we have learning collaboratives, not only do we have learning collaboratives within each of these spheres, but we learn from each other in these similar projects, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Earlier this month, CMS announced that 561 accountable care organizations will be participating in the Medicare Shared Savings Program in 2018, with 10.5 million assigned beneficiaries.

Given that 2018 marks the last year of the transition-year policies, implementation challenges identified during the first 2 years of Medicare Access and CHIP Reauthorization Act (MACRA) preparation and execution must be addressed to ensure effective delivery of high-value care as intended.

A study evaluating the association between hospital sharing of electronic health record diagnostic information and hospital quality using Hospital Compare scores.

Hospital participation in Meaningful Use was associated with reduced disparities in 30-day readmissions for African American Medicare beneficiaries.