Value-Based Care

Innovative care delivery programs intended to improve quality and reduce costs need sustainable business models in order to last beyond the end of grants or other methods of time-limited funding. RAND researchers take a look at methods Massachusetts health plans and accountable care organizations are using.

To improve accountability in healthcare, physicians are continually tasked with checklists to ensure quality. But where is that leading to?

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.

Coverage of the 64th Scientific Sessions of the American College of Cardiology.

The most sweeping overhaul of Medicaid regulations since 2002 is due soon. So far there are few hints at what CMS may require states to do as they award managed care contracts in an effort to better coordinate care and control costs.

The realm of cancer care remains a holdout in the movement toward value-based payment models, with implications for cost and health outcomes, according to authors of a new article in The American Journal of Managed Care. Authors from the Center for Health Policy at the Brookings Institution assert that new payment models can be adopted by all payer and provider types, with benefits over the traditional fee-for-service model.

The authors examine 4 alternative payment models for oncology care that shift away from fee-for-service and move progressively toward greater bundling, either across providers or across payments.

This week The American Journal of Managed Care launched its new Managed Markets News Network, featuring the top stories in managed care and interviews with industry experts.

At the Medical Home Summit in Philadelphia, Lisa Letourneau, MD, executive director of Maine Quality Counts, told the audience that ACOs have not had as much an impact on healthcare cost because a lot of primary care payments are still made under the old fee-for-service model.

Increased care fragmentation among chronically ill, commercially insured patients is associated with higher costs and lower quality of care.

The theory that a lack of coordination leads to poor health outcomes and higher costs drives US healthcare policy. But for the first time, a new study in The American Journal of Managed Care measures this phenomenon-and confirms it.

The Pioneer ACO Model successfully reported smaller increases in total Medicare expenditures and reductions in health service utilization, for savings of approximately $385 million during the first 2 years compared with general Medicare fee-for-service.

As accountable care organizations work to deliver population health, patient satisfaction, and cost savings, the need to engage patients as partners in their own healthcare has never been more essential. The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, gathered this week at the historic Hotel del Coronado in San Diego, California, to explore ways to make patients the starting points of healthcare, not just its recipients.

Given the diverse stakeholders in attendance, the hallway conversations at the ACO and Emerging Healthcare Delivery Coalition Spring 2015 meeting in San Diego, California, were just as interesting as the sessions, according to Anthony D. Slonim, MD, DrPH, president and chief executive officer for Renown Health, and co-chair of Coalition.

The use of a tiered network was associated with the increased use of hospitals on the preferred and middle tiers for planned hospital admissions compared with the nonpreferred tier, according to a paper in Health Services Research.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, will host its first meeting on the West Coast April 30-May 1, 2015, at the Hotel del Coronado in San Diego, California. An outstanding group of faculty will take part as this multistakeholder group meets for the first time since the announcement of the ACO "Next Generation" initiative.

One of the challenges providers will face in the new Oncology Care Model that CMS announced earlier this year is measuring quality and meeting quality standards under, according to Patti Forest, MD, MBA, senior medical director of network quality and performance at Blue Cross Blue Shield of North Carolina.

Accountable care organizations were created under the Affordable Care Act to improve healthcare delivery to a defined population. As writers in the new issue of Evidence-Based Oncology discuss, while palliative care exists to raise the quality of life for the seriously ill, it can also speak to the value equation of delivering care that patients want at a lower cost.