Value-Based Care

Neil M. Pressman, FACHE, president, Presscott Associates, discussed a variety of business models for healthcare network management in his presentation at the National Association of Managed Care Physicians' Spring Managed Care Forum 2014 in Orlando.

Providers and insurers alike know that focusing on quality and cost will be essential, especially as healthcare shifts toward accountable care models.

With the delay in ICD-10, many insurers now have to slow down a mammoth IT project and, potentially more disruptive, make adjustments to a whole slew of programs and contracts.

Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.

Lee Newcomer, MD, MHA, of Oncology, Genetics and Women's Health for UnitedHealthcare, says the National Comprehensive Cancer Network is transforming genetic testing by utilizing a tool called the NCCN Biomarkers Compendium, which encourages evidence-based decision-making.

The Obama administration's top Medicare official is stepping down from his post. CMS Principal Deputy Administrator Jonathan Blum has been with the agency for more than five years.

Current healthcare payment systems in the United States are all plagued by the problem of adverse incentivization. A more efficient system would be one which leaves billing entities uncertain of how a given patient encounter will be reimbursed.

As the structure of the healthcare system changes rapidly, patient-reported outcomes provide clinicians with a different set of tools for promoting health.

Cancer survivors often encounter a variety of health issues, the most common of which include fatigue, peripheral neuropathy, and depression. To address those specific issues, the American Society of Clinical Oncology (ASCO) has developed 3 new sets of guidelines on cancer survivorship care.

Simply put: When you're under observation, you're often less insured.

The Obama administration's timeline for having ready the new healthcare law's online sign-up system "was just flat out wrong," outgoing Health and Human Services Secretary Kathleen Sebelius said in an interview that aired Sunday.

EHRs - and the data they hold - are critical to succeed in population health, but they're not enough.

Karen DeSalvo, MD, the national coordinator for health information technology has proposed that ONC become more forward-thinking.

Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president, Joslin Diabetes Center, says that there are opportunities for treating diabetes within accountable care organizations (ACOs).

Supporters point to advances such as greater takeup of EHRs by doctors, though critics say federal policymakers pushed technology long before it was ready.

Just over half of the 114 organizations to join one of two Medicare accountable care organization efforts in 2012 report no decrease in health spending below targets during their first 12 months.

Heartland Regional Medical Center had more to lose than most when it gambled and joined Medicare's experiment with accountable care in 2012. For the first year at least, that risky bet paid off.

The American Society of Clinical Oncology (ASCO) has launched a strategic initiative to define value in cancer care.

Peter B. Bach, MD, MAPP, director, Center for Health Policy and Outcomes, says accountable care organizations and patient-centered medical homes are trends driven by macro issues, which include decreased reimbursement to private practices and drug discounts from the 340B program.

The Medicare Payment Advisory Commission (MedPAC) recently aired concerns as to whether the patient-centered medical home (PCMH) can serve as a model for providing value-based care. In particular, several members asserted that the medical home model may have a real cost disadvantage for health systems. They explained that without evidence-based research, it is difficult to determine if the model encourages practices to use their cost savings to improve care.

As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers?

Gary Liska, with Alere Home Monitoring Inc, says Alere's commitment to patients' safety is why they supported the STABLE study.

Figures from 2010 show that 71 Chicago-area hospitals covering seven counties discharged about 1.02 million patients; by 2012, that number had dropped about 5 percent, to 970,000 discharges, according to the January report.

As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies.

This article reviews the mobile clinic sector's impact on access, quality, and costs, and explores postreform opportunities for leveraging them nationally.