Value-Based Care

The Affordable Care Act was implemented to change healthcare in the United States. In order to support that change, the government established the Center for Medicare and Medicaid Innovation (CMMI)-a sector of the government agency that aims to incentivize innovation among providers and payers.

Len Nichols, PhD, director of the Center for Health Policy Research and Ethics (CHPRE) and a professor of Health Policy at George Mason University, describes how medical tourism improves care while lowering costs.

Next year, U.S. healthcare providers will be subject to Medicare penalties if they do not meet up to 26 measures for value-based purchasing.

Six of the most prominent healthcare systems in Wisconsin have created a new partnership, jumping on the nationwide bandwagon of forming strategic alliances to share information, while remaining independent.

This study sought to explore if shifting care to nurses in cardiovascular risk management in primary care is a key to more structured chronic care.

Amy Berman, BS, RN, senior program officer at the John A. Hartford Foundation, says that the triple aim promotes better health, better care, and lower costs. All too often, however, current oncology treatment regimens do not achieve the triple aim.

Management of hepatitis C screening results can be optimized to ensure that patients receive high-quality care, reducing morbidity and costs related to the virus.

The CMS has finalized a rule (PDF) that decreases inpatient prospective payment system payments by $756 million overall. Meanwhile, long-term-care hospitals will see payments increase by 1.1%, or approximately $62 million in fiscal 2015, which starts Oct. 1.

CMS has announced that it will nearly double the number of candidates in its bundled payment program. As part of the Affordable Care Act, the program aims to reduce care costs and improve patients' quality of care by offering providers with an alternative to the traditional fee-for-service reimbursement model.

Thirty medical home pilot primary care practices had high structural capabilities at baseline and performance improved substantially after 24 months in practices starting with lower capabilities.

The University of Buffalo is working to limit patient readmissions to hospitals and ERs via use of dashboard technology.

As healthcare reform advances, experts say, dermatologists face mounting pressure to prove their mettle to insurance exchanges and accountable care organizations (ACOs).

To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.

On the second day of "Patient-Centered Diabetes Care: Putting Theory Into Practice," Jan Berger, MD, MJ, president of Health Intelligence Partners, moderated the panel discussion "Measuring the Impact of Pharmacists in Diabetes Patient Care."

Dr. Vojta emphasized the importance of analyzing existing good patient data to improve care outcomes.

As part of its mission to bring together stakeholders engaged in implementing the Affordable Care Act, The American Journal of Managed Care created the ACO and Emerging Healthcare Delivery Coalition, which gives participants opportunities to share best practices in using new reimbursement models. The final panel of "Patient-Centered Diabetes Care: Putting Theory Into Practice" invited ACO Coalition members to present insights on diabetes care.

Pearson emphasized a coordination of care, between the primary care provider, the pharmacist, and payers, to improve patient care.

Personalized medicine will be expensive in these early days of pioneering and planning. But individual genomic testing is not going to be exorbitant forever — and the ROI is gonna be big, both in patient outcomes and dollars saved.

When it comes to value-based decision making, several factors can influence physician behavior. Although many organizations rely on financial incentives, the Commonwealth Fund argued in a report released Tuesday that healthcare leaders should think beyond the dollars and dimes.

More than 8 million Americans have signed up for health insurance thanks to the Patient Protection and Affordable Care Act. Significantly increasing access to care, the 4-year-old healthcare reform law also creates incentives for providers to reorganize the delivery of healthcare.

It is well known that oncology care pathways are the tools that practices can utilize to care for its patients. Ira Klein, MD, MBA, FACP, chief medical officer, National Accounts Clinical Sales & Strategy, Aetna, suggests that Aetna's only involvement in creating these pathways should be in helping these practices develop "reasonable care pathways."

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, hosted a recent Web-based session that featured three presentations on aspects of the transition to value-based care: why barriers to change persist, what steps one ACO is taking to drive better health, and why a "patient-centered" method of picking a doctor makes sense.