Value-Based Care

On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.

As provider and payer organizations pursue the Quadruple Aim, it is important that they take into account not just the contracting but also the transformation in staffing, clinical workflows, and culture as these organizations evolve.

Among adults with newly diagnosed cancer, rates of low-value cancer services persisted throughout the COVID-19 pandemic in areas ranging from peridiagnosis imaging to end-of-life care.

To deliver on the promise of value-based care, organizations need to return to the fundamental objective: to deliver high-quality, affordable care to our communities.

Engaging specialty physicians is an emerging area of focus for Medicare accountable care organizations. Enhanced data on specialist costs and outcomes are essential to addressing alignment challenges.

For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

This article analyzes the use of MRI in a national sample of patients with wrist pain before and after consensus guideline publication.

Through accountable care organizations, physicians are leveraging data and partnerships to create an efficient, quality-oriented system focused on improving patient outcomes and addressing health disparities.

No generalized statements regarding nurse practitioners’ low-value care ordering practices can be made due to limited evidence, indicating a need for further research.

At an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care® and Optum, speakers emphasized that innovation is urgently needed in primary care delivery to address the broken US health care system.

If we are to achieve the clinical and economic benefits of primary care and care continuity, the implementation and evaluation of strategies that reward clinicians and patients are warranted.

Experts discussed the Enhancing Oncology Model and themes in the movement toward value-based care in oncology during Patient-Centered Oncology Care 2023.

Health insurance enrollment through the Affordable Care Act (ACA) insurance marketplace has broken a record for the third consecutive year; attention-deficit/hyperactivity disorder (ADHD) treatment prescriptions for adults surged during the COVID-19 pandemic, contributing to lingering shortages; paying high rent can shorten your lifespan.

Kimberly Westrich, MA, of the National Pharmaceutical Council, explained how she envisions value assessment tools to be used in the US health care system in coming years.

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

In 2023, there were 18 oncology and 7 population health Institute for Value-Based Medicine® events cohosted with organizations such as Optum, OneOncology, Vanderbilt Ingram Cancer Center, Duke Health, Cleveland Clinic, and Memorial Sloan Kettering Cancer Center.

Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.

Top coverage from the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023 included sessions on value-based care implementation and best treatment practices.

Robert Groves, MD, of Banner | Aetna discusses the challenges primary care practitioners (PCPs) face when addressing social determinants of health (SDOH).

Patients seen at value-based care clinics received more preventive screenings and had lower risks of hospitalization and emergency room visits, according to Humana’s 10th annual value-based care report.

Michael Yim, MD, board-certified family physician, discussed the need for and logistics of collaboration between oncologists and primary care providers.

In an interview with The American Journal of Managed Care®, Grant Andres, BSc, DC, BSN, MSN-RN, senior director of clinical operations at Arizona Oncology, discussed the nuances of successfully implementing value-based care initiatives across a large organization.