Value-Based Care

It’s very unusual to see significant cost savings in the first year of a program; that was true of all the pioneer ACO programs, said Jeff Patton, MD, CEO of Tennessee Oncology.

Both accountable care organizations (ACOs) and narrow networks are important components of the value-based care movement. However, while there are features common to both models, Catalyst for Payment Reform has learned that what constitutes ACOs and narrow networks is inconsistent across health plans.

A recent study, published in JAMA Dermatology, investigated whether there was an association between insurance type and surgical delays for patients with melanoma.

With reimbursement increasingly tied to outcomes, health systems and practices are trying to find ways to reduce costs while delivering better care. Some of the most-read articles in The American Journal of Managed Care® (AJMC®) in 2017 included an analysis of the benefits of treating everyone with hepatitis C with new, expensive treatments, a program to reduce readmissions, and a look at the impact of value-based contracting in Medicare Advantage.

Contributors to AJMC.com delved into data to share their knowledge about important topics in managed care, and in 2017, these were the top 5 most-read articles they wrote and published on our online managed care network.

Coverage from the Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24 in Tysons Corner, Virginia.

Implementation of the Quality Blue Primary Care program in Louisiana was associated with a shift in primary care delivery and reductions in overall cost.

The conclusion drawn by panelists participating at the National Comprehensive Cancer Network’s Oncology Policy Summit on Redefining Quality Measurement in Oncology was that ensuring access to appropriate data and using that information to improve healthcare outcomes remains an ongoing challenge.

Speaking at the National Comprehensive Cancer Network Oncology Policy Summit on Redefining Quality Measurement in Oncology, Ronald Walters, MD, MBA, MHA, MS, associate vice president of medical operations and informatics at The University of Texas MD Anderson Cancer Center, emphasized the need to focus on the patient’s preferences and values in cancer care delivery.

The FDA has recognized the need to include the patient's voice in the drug development process. The question is: what is the best way to do this?

The participation of residents and physician assistants significantly increased patient wait time without reducing the attending surgeon’s consultation length in outpatient surgery clinics.

A growing number of clinicians specializing in nursing home care indicates the beginning of a new trend in healthcare, but the impact of these new specialists on outcomes remains unclear.

The review period in the report bridged a public scandal at the VA that forced the resignation of a former Cabinet secretary.

Catalyst for Payment Reform is leading a movement for employers and other healthcare purchasers to push for greater transparency into their health plans’ ACO arrangements.

In a Tuesday session at the American College of Rheumatology’s 2017 Annual Meeting in San Diego, California, Greg Mertz, MBA, FACMPE, managing director for Physician Strategies Group, LLC, presented a talk title “Value Contracting: Opportunities of Fantasy?” in which he outlined the current landscape for performance-based contracting.

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.

Following the transition year and ahead of the full implementation in year 3, CMS made provisions to the Quality Payment Program to make it easier for clinicians to participate in the program, reduce burden, and to get clincians ready for full implementation.

During the final panel at the fall meeting of the ACO & Emerging Healthcare Delivery Coalition® in Nashville, Tennessee, panelists discussed the progress specialties have made in moving to value-based payment models, as well as the challenges facing the industry as a whole. The panel consisted of 3 individuals who provided perspectives from specific specialties, and 1 with an overall policy perspective.

CMS just released 2016 data on the Medicare Shared Savings Program and the information proves that patience pays off, savings don't have to happen at the expense of quality, and that physician-led accountable care organizations are more successful.

At the fall ACO & Emerging Healthcare Delivery Coalition®, Clay Alspach, JD, principal at Leavitt Partners, discussed navigating the current political and payment reform landscape, making sense of the uncertainty, and preparing for the unexpected.

A back to back session and panel at the falls’ ACO & Emerging Healthcare Delivery Coalition focused on the importance of utilizing integrated healthcare to treat individuals with addiction and ensuring physicians are educated on understanding addiction.

This fall's ACO & Emerging Healthcare Delivery Coalition

David V. Axene, FSA, FCA, CERA, MAAA, outlined how more accurately measuring and evaluating the performance of accountable care organizations (ACOs) can help both health plans and providers succeed in their risk sharing contracts during a session at the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

Before physicians will be more willing to take on 2-sided risk, there needs to be clearer metrics that the physicians know will be achievable, said Sarah Cevallos, chief revenue cycle officer at Florida Cancer Specialists.

Global patient satisfaction was positively associated with quality of stroke care and higher discharge information satisfaction may be linked to worse outcomes. Additionally, improvements in satisfactions were linked to higher costs.

With confusion surrounding the meaning of “savings” with regard to ACO programs, authors writing in Health Affairs outlined 3 different types of savings.

A more integrated approach to managing complex member populations starts by moving beyond clinical care settings and extending services into the community. Community-based care drives more predictable costs, and goes a long way to making members’ lives better.

An in-depth look into a nationwide collaborative initiative to standardize and improve oncology dispensing practices for the benefit of patient/provider education, adherence, and overall care.

Brian Marcotte, president and CEO of the National Business Group on Health, offers recommendations for employers that are considering accountable care organizations (ACOs) and describes situations when an ACO is not a good fit.

Despite their large and growing reach, accountable care organizations (ACOs) are still learning how to manage their populations and are slowly accepting more financial risk, according to the results of the Annual ACO Survey from the National Association of ACOs and Leavitt Partners.