Value-Based Care

'In order to get technology to truly work for physicians, it must drive productivity'

There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug -and who pays for it.

Some of the same themes being raised across medicine-how to balance the quality of care with soaring therapy costs, and how to unleash the power of genomics to tailor treatment-were part of Saturday's workshop Hot Topics in Pediatric Allergy and Immunology. The session of the American Academy of Pediatrics took place during the 2014 Annual Meeting of the American Academy of Allergy, Asthma & Immunology in San Diego, California.

Session highlights from the Managed Markets Summit in Orlando, FL, February 25-27.

Laura Beerman, director, customer segment analysis, Decision Resources Group, presented a discussion that highlighted the early results of accountable care organizations (ACOs). She said that while the Pioneer ACOs created a large initial buzz, their cost savings has varied widely.

Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.

Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company.

It's a simple idea, but a radical one. Let people know in advance how much health care will cost them-and whether they can find a better deal somewhere else.

Federal officials issued the first set of voluntary standards under a new process that will give companies that develop electronic health-record systems more notice about what requirements will be included in the federal rules governing their products.

It is always important to remember that healthcare and health insurance are two very different things, and neither of them is a guarantee of good health.

Financial incentives alter the quality and quantity of care that physicians provide. Understanding physicians' recent experience with incentives may help shape current payment reform efforts.

While some patients and physicians are not aware of the costs of care, others are concerned about whether they can afford treatment options at all. Dr Miller describes some of the major steps to the incremental benefits and incremental costs incurred by new agents.

To improve care, policy analysts and health leaders recommend there be fewer and narrower quality measures.

Implementing the new ICD-10 procedural and diagnostic codes, which the CMS says must happen by Oct. 1, will be more expensive than previously estimated, according to new research. But costs will vary widely depending on practice circumstances.

In response to a request for comment issued by the Centers for Medicare & Medicaid Services on its proposed Quality Strategy, the American Hospital Association is calling for more significant alignment of its quality measurement activities in order to reduce the burden on hospitals and providers.

Current reform efforts seek to tie providers' pay with performance, yet a recent finding suggests that less than 15% of internal medicine residency programs provide education that focuses on such training.

The likelihood of a positive outcome for a patient across the continuum of care is closely tied to the ability of the patient's health information to follow suit.

The technological underpinnings for an accountable care organization (ACO) include all the basic healthcare IT you have heard so much about, including electronic health records (EHRs), electronic medical records (EMRs), and health information exchange (HIE) for transmitting patient data between participating organizations that are not necessarily all on the same EHR.

Steven D. Shapiro, MD, executive vice president, chief medical and science officer, University of Pittsburgh Medical Center (UPMC), says that when improving care, sometimes less is more.

The revision process for ICD-11 is currently underway and the final version will be released in 2017, according to a fact sheet from the World Health Organization.

Peter B. Bach, MD, MAPP, director, Center for Health Policy and Outcomes, and attending physician at Memorial Sloan-Kettering Cancer Center, says accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) may have the potential to drive cost savings, especially in clinical areas such as readmissions.

The Obama administration on Thursday reported what it called encouraging results from efforts to reduce healthcare costs and improve the quality of care for more than 5 million Medicare beneficiaries under Obamacare

The Centers for Medicare & Medicaid Services (CMS) reports that accountable care organizations (ACOs) that participated in its Shared Savings program during 2012 saved $380 million in health spending. However, more than half of the 114 participating organizations did not produce any savings.

The Certification Commission for Health Information Technology is getting out of the business of testing and certifying electronic health-record systems after nearly a decade as the first and still most-commonly used provider of those services in the U.S.

Office visits are likely to decrease as both physician and patient rely more on digital tools, study concludes.