Value-Based Care

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.

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.