Value-Based Care

Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

The future of medicine will be creating partnerships with other providers and other healthcare organizations that are like-minded and looking to enter into value-based modes of care to create networks taht aren't narrow but are coordinated and high performing, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

The Medicare Shared Savings Program is the perfect way for primary care physicians to get involved with alternative payments as Medicare moves to replace fee-for-service, explained Hymin Zucker, MD, chief medical officer of the Triple Aim Development Group.

The government is leading the charge toward value-based care and no matter how slowly, everyone else will follow, said Jacque Sokolov, MD, chairman and CEO of SSB Solutions, during the opening keynote presentation at the Fall Managed Care Forum 2015.

When accountable care organizations first started forming, the country thought it would be easier than it has been, but finding the right partner is crucial, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

As the healthcare industry moves toward population health and improving quality and value, The American Journal of Managed Care (AJMC) is in a good position to help lead the change, according to Rose Maljanian, RN, MBA, chairman and chief executive officer of HealthCAWS and a member of the AJMC editorial board.

Getting health information technology (IT) to work in one provider system can be difficult enough, but in ACOs, they have multiple systems on different platforms, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

While there are reports of high patient satisfaction and well-managed costs in the Medicare program, the next 50 years will be full of new challenges, said Andrew Slavitt, acting CMS administrator, during the opening session at America's Health Insurance Plans' National Conference on Medicare.

Now that accountable care organizations are up and running, the key will be engaging those with the greatest potential to make or break their bottom lines-patients. Last week's meeting of the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, examined why changing mindsets may matter more than technology or measurement.

A new study in JAMA Internal Medicine has found that financial integration between physicians and hospitals has led to higher spending in outpatient care.

What we're reading October 19, 2015: Clinton campaign leads rivals in pharma donations, lawmakers in North Carolina open to provider-led organizations and managed care, big surge in Medicare spending on hepatitis C drugs.

As the country moves from volume to value, accountable care organizations (ACOs) can play a key role during the transition from fee-for-service. How well do you know ACOs?

Gaps in accountable care measure sets can be addressed efficiently using priority measure types and innovative approaches to measurement.

Taking aim at payment models for patients on dialysis is the latest attempt to target high-cost areas of Medicare spending.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

With the goal of accountable care organizations and population health being patient centric, it is important that stakeholders involved in the care of the patient develop partnerships to deliver high-quality care in a cost-effective manner, explained René Lere, MD, president of Florida Blue and GuideWell.

There are 3 main risks to the sustainability of accountable care organizations and the move to accountable care, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

As the country increases the pace of shifting to value-based payments, a significant question remains: how can independent primary care doctors operate in this new environment?

Transitioning to a healthcare system based on accountable care presents many challenges, though the potential benefits may be well worth the effort.

This article examines the features a care coordinator should look for in care coordination tools to ensure they meet the needs of patients, the care team, and the care coordinator.

Gaps in ACO implementation readiness are identified as appointment reminders, referral follow-ups, care management, care transition alerts, clinical quality measure knowledge, and resources.

The American Journal of Managed Care and the Robert Wood Johnson Foundation will host a Tweetchat September 29 from 11 am to noon EDT on the Culture of Health and the impact of accountable care organizations (ACOs).

Focusing on quality and quality measurements has the potential to reduce costs, increase quality, and deliver more value to patients, consumers, and customers.

To provide guidance for successful partnerships, the authors identify common themes from their experience with successful health plan/medical group partnerships programs.

The characteristics of patients who visit practices that are ready versus unready for the patient-centered medical home differ in important ways.

As CMS pushes healthcare systems to move away from fee-for-service, the state's largest insurer makes a major move toward value-based payment.

There are a couple of health information technology challenges facing new accountable care organizations that are bringing together different entities with disparate systems that need to learn to work together, explained Scott Berkowitz, MD, MBA.

The first year to 18 months of an accountable care organization (ACO) is the most challenging as data begins to trickle in of everywhere a patient went to get care, and healthcare providers typically aren't taught how to utilize that information, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

The top managed care news this week included draft guidance to reign in the controversial 340B drug program and the top pharmacy benefit managers made it clear they are looking for price discounts for the PCSK9 inhibitors.

Leah Binder, president and CEO of The Leapfrog Group, will be the keynote speaker at the upcoming meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held October 15-16, 2015, in Palm Harbor, Florida. The Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across healthcare to share ideas for navigating the changing reimbursement landscape.