Value-Based Care

Michael Evans, RPh, director, ambulatory clinical pharmacy programs, says that medication therapy management (MTM) programs present various challenges. In particular, those challenges include medication reconciliation, ensuring that patients are adherent to their medications, and clinician prescribing practices.

Integrated healthcare systems, with associated providers and health plans, have a leg up on implementing accountable care organizations to improve care and lower costs. Leaders from two Washington-based integrated systems shared some best practices and lessons learned for ACO success during a panel discussion Thursday at the AHIP Institute in Seattle.

Healthcare stakeholders suggest that the key to success for any accountable care organization (ACO) is its mix of data analytics and patient accountability.

David Alain Wohl, MD, associate professor, division of infectious diseases, University of North Carolina at Chapel Hill, suggests that quality management of HIV has, for the most part, been self-regulated. He says that when it comes to HIV management, there is a lack of feedback or "quality improvement mechanisms" outside the managed care setting.

The continued advances in cancer treatment are improving patient survival, but the healthcare industry is bursting at its seams.

Deneen Vojta, MD, UnitedHealth Group, says that the healthcare landscape is shifting to delivery models that focus on greater value-based care, such as accountable care models.

Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.

The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.

David B. Hoyt, MD, FACS, executive director, American College of Surgeons (ACS), says that his organization has studied the concept of improving and sustaining quality while lowering costs. They find there are a variety of results when it comes to hospitals creating, meeting, and maintaining quality standards.

Robert Gabbay, MD, PhD, discusses the changes he wishes to see in the healthcare system that he calls a "journey toward quality," and with his work at the Joslin Diabetes Center, he dreams of ridding the world of diabetes by implementing innovation.

For oncologists and other cancer care specialists, value-based care is essential.

The second day at the 50th annual meeting of the American Society of Clinical Oncology ended with a session entitled "Health Care in America in 2014: Current and Future Implications of the Patient Protection and Affordable Care Act" (PPACA). The presenters provided an overview of the recent and anticipated changes related to the PPACA as well as its timeline.

"The Value of Cancer Care and the Professional and Ethical Obligations of the Practicing Oncologist: A Debate" delved into the ethical issues raised by the economic reality of the rising costs of cancer care for the practicing oncologist.

While the incidence of cancer continues to grow, novel and targeted therapies being developed have seen much improved survival for even the deadliest of cancers. New innovations in cancer diagnosis and treatment are associated with high cost. Cancer therapy constitutes nearly 11% of the total healthcare budget, and it is rapidly growing.

The nation's healthcare system needs to follow the lead of the aviation and manufacturing industries and adopt a systems-engineering approach to quality improvement, but fee-for-service payments and an inadequate health data infrastructure are obstacles to doing so, according to a new report from the President's Council of Advisors on Science and Technology.

Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS' Office of Inspector General said in a study released Thursday.

Physicians are wary of new healthcare payment models emphasizing quality and efficiency metrics, but hospitals are likely to prove resilient.

As part of a contract extension with Tenet Healthcare, Cigna has established a first of its kind quality-based reimbursement agreement.

Anthony Slonim, MD, DrPH, CPE, FACPE, executive vice president, chief medical officer, at Barnabas Health says that being a member of The American Journal of Managed Care's ACO and Emerging Healthcare Coalition is valuable.

In an era of heavy-duty strategies and tough decisions, one healthcare expert urged providers to consider the accountable care organization (ACO) as part of their future.

NCCN Guidelines Updates

Three major insurers are partnering with a not-for-profit group to provide consumers with greater access to healthcare cost information, the group announced Wednesday morning.

The CMS has canceled its first scheduled round of end-to-end testing for ICD-10 in the wake of a recent, one-year reset of the compliance deadline to Oct. 1, 2015, according to knowledgeable sources.

Final rule reduces burdens to critical access hospitals, rural clinics; loosens physician supervision requirements.