Value-Based Care

In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.

At the fall live meeting of the ACO & Emerging Healthcare Delivery Coalition in Philadelphia, Pennsylvania, attendees heard presentations and participated in workshops that discussed care management, value-driven payment systems, and the future of healthcare.

When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations.

The opportunities for telehealth to radically transform the healthcare system are enormous, but the foremost priority of these innovations must be the delivery of value, said Reed V. Tuckson, MD, FACP, at the National Committee for Quality Assurance Quality Talks conference in Washington, DC, on Monday.

Employers face tough decisions about rising costs, high-quality care, coordination of benefits, and workplace accommodations when employees are diagnosed with cancer, but they will always want to support those employees as best they can, according to Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health.

The healthcare community needs to understand and address the personal and social circumstances that contribute to a patient’s health before they can improve the quality of care, according to 2 presentations in the first segment of the National Committee for Quality Assurance Quality Talks conference in Washington, DC.

One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

The number of accountable care organizations (ACOs) has grown rapidly over the last 4 years, with more than 800 ACOs now covering an estimated 28 million Americans. A study found that commercial ACOs were significantly larger and more integrated with hospitals and had lower benchmark expenditures and high quality scores compared with noncommercial ACOs.

Despite progress, tying healthcare payments to value has proved easier in theory than in practice, according to speakers at this fall’s meeting of the ACO & Emerging Healthcare Delivery Coalition. Experts convened October 20-21, 2016, by The American Journal of Managed Care looked ahead at the challenges the next president will face with the future of the Affordable Care Act.

Accountable care organizations (ACOs) have been laying the groundwork for the requirements for the Medicare Access and CHIP Reauthorization Act (MACRA), which will give physicians participating in ACOs an advantage during the implementation of the new Medicare payment system, said Katherine Schneider, MD, president of the Delaware Valley ACO.

The innovative strategy of hotspotting, implemented by the Camden Coalition of Healthcare Providers, was the focus of a session and a panel discussion during the first day of the ACO & Emerging Healthcare Delivery Coalition.

Panel members discuss the level of physician awareness regarding changes that will follow the implementation of CMS’ recently released Medicare Access and CHIP Reauthorization Act (MACRA).

In the keynote speech at the ACO & Emerging Healthcare Delivery Coalition, Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy, started out by providing a broad picture of Medicare reform before narrowing it down to what is happening on the ground.

Healthcare attorney James M. Daniel, Jr, JD, MBA, explained how healthcare providers will be impacted by CMS’ newly released final rule on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) in a session during the second day of the ACO & Emerging Healthcare Delivery Coalition.

Over the last 4 years, the ACO & Emerging Healthcare Delivery Coalition has continued to grow as a result of the opportunities to hear about innovations in accountable care organizations (ACOs) and to network with a diverse group of people, said Anthony Slonim, MD, DrPH, president and CEO of Renown Health and chair of the ACO Coalition.

The Camden Coalition of Healthcare Providers utilizes hotspotting to identify the most complex and costly patients and enrolls them in a care management program to empower them to take control of their own healthcare.

Communication gaps complicate healthcare and can devastate the prognosis of a patient undergoing cancer treatment. Here are a few ways to overcome inconsistencies with cancer care delivery

ACOs have great potential in helping achieve a more value-based delivery system, said Risa Lavizzo-Mourey, MD, MBA, outgoing president and CEO of the Robert Wood Johnson Foundation. She also discussed the challenges that safety net ACOs face in delivering care with fewer resources.

Today, federal officials released the final rule for the Medicare Access & CHIP Reauthorization Act (MACRA), which will overhaul the way doctors are paid. To understand what this rule means to the future of value-based healthcare, join The American Journal of Managed Care October 20-21, 2016, in Philadelphia for the fall meeting of its ACO & Emerging Healthcare Delivery Coalition.

To discuss the progress in care collaboration and also what is currently lacking in care practices in oncology, The American Journal of Managed Care® invited Rebekkah Schear, MIA, LIVESTRONG Foundation, and Michael Kolodziej, MD, Flatiron Health.

HHS has issued its final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), which reforms the Medicare payment system as part of the shift to value-based care. Here are 5 things to know about the final rule.

Clinicians may at first be confused by new value-based care regulations, but there are resources to help them understand, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Payment reform in the United States is moving quickly, but there are still a lot of unknowns among providers. Meetings like the ACO & Emerging Healthcare Delivery Coalition help accountable care organizations (ACOs) and providers share best practices and figure out how to succeed, said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and keynote speaker at the ACO Coalition's fall meeting in Philadelphia, Pennsylvania, October 20-21. Learn more about the meeting and register.

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With 6 years under his belt, Patrick Conway, MD, is the longest serving chief medical officer in CMS history. During those 6 years, he has seen alignment with private payers increasing, Conway said during a plenary session at the fall meeting of the National Association of Accountable Care Organizations.