Value-Based Care

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The top managed care news this week included draft guidance to reign in the controversial 340B drug program and the top pharmacy benefit managers made it clear they are looking for price discounts for the PCSK9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

The results for 2014, which was Year 3 of the program, revealed winners and losers and showed that ACOs may not be the only solution to hold down the cost of healthcare.

As the United States progresses toward improving health and healthcare while lowering cost, the need for standardized, evidence-based measures becomes all the more important.

With various healthcare stakeholders having different wants and needs from the healthcare system, meetings that bring all parties together in one room are important, according to Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, and keynote speaker at the spring live meeting of the ACO and Emerging Healthcare Delivery Coalition.

Analysis of publicly reported organizational characteristics, shared savings distribution plans, and early financial success of accountable care organizations in the Medicare Shared Savings Program.

This editorial reviews the recently published study (AJMC April) by Gerrard et al, which analyzed the statistical prediction model of the Fitness Index Measure for hospital readmission in unilateral hip fractures.

A report from the Government Accountability Office has found that a program for hospitals serving poor and uninsured patients has created perverse incentives to prescribe more drugs and more expensive drugs, particularly in the area of cancer care.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

The approach for assessing hospital penalties under the Hospital-Acquired Condition Reduction Program might need to be reconsidered in order to achieve the intended goal of the program.

As clinical targets in more common malignancies emerge, testing and treatment options will increase. Balancing these choices with the high costs of new technology will be the challenge to ensure value in oncology care.

The potential of nurse practitioners is not being fully realized in primary care medical practices. Consequently, cost and quality gains are not being achieved.

Accountable care organizations can play a key role in building a Culture of Health in which every person in America can have the healthiest life possible.

This study examines the association between plan-level measures of health outcomes and medication adherence to assess the viability of adherence as a measure of plan performance.

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

Cigna and Providence-Swedish Health Alliance ACO in Western Washington recently launched a care collaboration initiative that will benefit more than 7100 individuals who are covered by a Cigna health plan.

When The American Journal of Managed Care's ACO and Emerging Healthcare Delivery Coalition met for the most recent Web-based session, the speakers discussed the importance of accountable care organizations as CMS moves forward with new reimbursement schemes and managing high-risk patients through coordinated care.

Two new changes to CMS' ACO Investment Model will help practices in rural areas gain more access to the benefits of accountable care organizations.

Among the 20 chronic conditions with the highest impact on the Medicare population, some have no quality measure, which limits Medicare's ability to pay for value.