Value-Based Care

Among Michigan primary care practices, sustained participation in a pay-for-value program appears to contribute to improved utilization outcomes for high-need patients.

This year, the most read articles from The American Journal of Accountable Care® explored how healthcare providers and payers have implemented innovative ideas to reduce spending while maintaining or increasing the quality of care.

CMS is moving full-steam ahead with the transition to value-based care. On Tuesday, the agency announced 3 new bundled payment models in cardiac care, an expansion on the Comprehensive Care for Joint Replacement Model, and the highly anticipated new track in the Medicare Shared Savings Program.

Along with the peer-review research, journal articles, and news coverage, The American Journal of Managed Careâ„¢ (AJMCâ„¢) has a robust multimedia component that brings together stakeholders from across the healthcare industry to discuss important topics in the world of managed care and delve deeper into topics.

What we’re reading, December 20, 2016: Purdue Pharma, which makes OxyContin, plans to expand its sales of the drug in foreign markets; family members blame hospital for not warning them about low-quality nursing home; a project to place blast sensors on soldiers to learn more about concussions has been discontinued.

CMS must learn from implementation of new quality measure sets as it refines and expands the Core Quality Measure Collaborative, Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Integrating behavioral and physical health services within an accountable care organization offers a significant opportunity to address both behavioral health conditions and substance use disorders, as well as to improve outcomes and reduce costs.

Recent election results raise questions about the future of healthcare programs and the coordination of patient care in our nation.

A new accountable care organization (ACO) model announced by CMS aims to improve care and lower costs by allowing beneficiaries enrolled in both Medicare and Medicaid to be covered under a Medicare Shared Savings Program ACO.

The authors describe best practices for Web design in the accountable care organization space in order to enhance engagement with patients and providers.

The Department of Veterans Affairs healthcare system has announced a final rule that will grant full practicing authority to some types of advanced practice registered nurses, with the exception of nurse anesthetists.

The Delaware Valley Accountable Care Organization (ACO) was disappointed to learn that under CMS’ Medicare Access and CHIP Reauthorization Act (MACRA) final rule, the practice would not be categorized as an advanced alternative payment model (APM) and would likely have less of an upside under the Merit-based Incentive Payment System (MIPS), said Katherine Schneider, MD, president of the Delaware Valley ACO. However, Dr Schneider said she understands CMS’ point of view and why it needed to make changes to the final rule.

Hospitals participating in accountable care organizations (ACOs) have greater adoption of health information technology, particularly patient-facing technology and health information exchange, than non-ACO hospitals.

Diabetes educators are well-positioned to help accountable care organizations meet their business, healthcare, and financial goals. The emphasis on primary care in treating chronic disease calls for an increased emphasis on diabetes educators to achieve better healthcare outcomes in a cost-effective manner.

Barry Russo, CEO of The Center for Cancer & Blood Disorders, said that his practice continues to collect quality and claims data from a number of sources, even though it isn’t easy. Russo also said that payers are not particularly interested in participating in a value framework, instead choosing to focus on the oncology care model (OCM).

Though there are many unknowns regarding how the Trump administration will affect policy, there is bipartisan support for lowering costs and increasing quality. The Medicare Access & CHIP Reauthorization Act of 2015 is a separate law that was passed with 92% bi-partisan support in 2015. Read on for tips on creating a strategy that will set you up for success under advanced alternate payment models.

In Hennepin County, Minnesota, which has one-fifth of the state’s population, the government has worked with the healthcare system to create a different way to care for people.

Innovative funding models like value-based payments can change providers’ incentives and drive them to seek solutions like palliative care, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

Relationships with accountable care organizations and provider organizations can help payers join in a value-based, holistic approach to improving health within a community, said Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

Bundled payments are an interesting experiment, but they should have more clinically relevant time periods and include more quality measures, said Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

The group that represents 5000 hospitals outlined a policy agenda that calls for regulatory reform but also seeks some certainty that patients who gained coverage under the Affordable Care Act will be able to retain it in the future.

Access to dermatology care is limited around the world, especially in remote areas, but the Veterans Affairs' teledermatology program aims to improve both access to and quality of dermatological care, said Nellie Konnikov, MD, professor and chief of dermatology at the Boston Department of Veterans Affairs.

Patients who received care for their chronic diseases in a patient-centered medical home had higher rates of medication adherence over 12 months than patients treated elsewhere, according to a study in the Annals of Internal Medicine.

Accountable care organizations are seeking to expand population health management capabilities through relationships with community organizations and patients, according to a new report.

Accountable care organizations all over the country have shown that no single method can work for every system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation.