Tag Archives: Value Based Health Care
True value-based care is a trillion-dollar unicorn for the health care industry
True value-based care is a trillion-dollar unicorn for the health care industry
In Silicon Valley, Kendall Square, and points in between, unicorns are more than mythical creatures that adorn software engineers’ ironic T-shirts. They’re disruptive technology behemoths with billion-dollar-plus valuations. These beasts have largely shied away from the health technology sphere over the last decade, despite many promising upstarts. Maybe we’ve been hunting for the wrong kind.
Get ready for the uber-unicorn. It won’t be a single, enormous company with a trillion-dollar valuation. Instead, it’s a movement called value-based care.
Value-based care isn’t a new concept. But it’s been used a bit bashfully, traditionally referring to carrot-and-stick-based incentive payments and penalties for physicians. Today these pale in comparison to the fee-for-service care that rewards reactive, episodic, paternalistic care — and lots of it.
Here’s what I mean by true value-based care: fully capitated payment contracts in which a lump sum of money is available to treat a patient over the course of a year. No penalties or incentives, simply ownership of the total cost of care and the total cost of outcomes. The better the care, the more money the organization bearing the risk receives. This is how to best reward exceedingly efficient, effective health care.
‘Somewhere in between’: Finding the balance between quality and the bottom line
As healthcare continues its shift from fee-for-service to value-based care, hospitals and health systems are working steadily to try and improve quality while reducing costs. However, striking a balance between the two can be challenging.
At the Becker’s Hospital Review 5th Annual CEO + CFO Roundtable on Nov. 8 in Chicago, healthcare experts discussed how their entities balance rewarding physicians for quality and clinical activity in what is still primarily a fee-for-service environment.
“We’re not totally in a fee-for-service environment. We’re not totally in a value-based care environment. We’re kind of somewhere in between,” said Patrice M. Weiss, MD, executive vice president and CMO of Roanoke, Va.-headquartered Carilion Clinic. “In the past, the two were felt to be mutually exclusive, but recent models of care have demonstrated that quality of care can be delivered in a low-cost model.”
While the shift from fee-for-service to value-based care is slightly slower in coming to her organization’s region, they are preparing, according to Dr. Weiss.
Carilion is a nonprofit organization with a network of hospitals, primary and specialty physician practices and other complementary services. The health system offers physicians a base salary, as well as a Tier 1 bonus and a Tier 2 bonus. The Tier 1 bonus is based on scorecard measures, which include quality metrics, patient experience metrics and operating margin.
“We have found we’ve been able to reduce the cost by using evidence-based medicine, standardization of care and appropriateness of testing and imaging,” Dr. Weiss said. “This reduced utilization has not reduced the quality of care or outcomes but has reduced the cost of care, thereby positively affecting our operating margin. So improving quality care and reducing the cost of care are not mutually exclusive.”
Physician-led, cost-reducing initiatives and physician engagement have been primary drivers in achieving reduced costs and improved quality, according to Dr. Weiss. For instance, Carilion has a significant physician-led initiative on early elective inductions or deliveries. This initiative, which was based on national guidelines, resulted in less utilization of obstetrical resources at an earlier gestational age.
The 1 thing about healthcare that needs to change: 4 executives weigh in
From the shift to value-based care to increased price transparency, the healthcare industry is in the midst of significant changes that are aimed at efficiently improving care. However, for that goal to be achieved, problems in the industry such as disparity in access to care and confusing billing systems still need to be addressed, according to healthcare executives.
In a panel discussion on Nov. 9 at the Becker’s 5th Annual CEO + CFO Roundtable in Chicago moderated by Rhoda Weiss, PhD, nationally recognized consultant, speaker, and author, four great minds in healthcare discussed the changes they would like to see in the industry, what gives them pride in their organizations and the issues that keep them awake at night.
Hospital executives’ 12 most pressing post-election questions, answered
In a stunning upset, Donald Trump took the stage early yesterday morning to claim victory as the next president of the United States while Republicans celebrated retaining control of both the House and the Senate.
While the outcome of the election has long been expected to have a far-reaching impact across a number of policy areas, the Republican sweep of Congress and White House could result in profound changes in health policy after a hard-fought election on both sides of the aisle.
Although the exact implications of the race will become more apparent in the coming days and weeks, we expect Republicans to emphasize the election results as a mandate for change and use the opportunity to pursue significant new initiatives.
So what can providers expect from a Trump administration and a GOP Congress? Let’s take a look at what’s potentially in store for Medicare, Medicaid, and the private insurance market—and what those changes mean for provider strategy—by looking at the most common questions I’ve already received following the election.
Regulatory, Legal Uncertainties Are Barriers To Value-Based Agreements For Drugs
The past several years have seen an increasing number of new and innovative therapies entering the drug market. Many of these are precision medicines developed to treat a narrowly defined patient population, often with a previously unmet need. These treatments have demonstrated success in improving quality of life and other important health outcomes among indicated patients in clinical trials, but there is uncertainty about patient response rates in real-world settings. These uncertainties have led payers to express concerns about the costs of some new medicines and to implement policies to control patients’ access to those medicines, such as higher cost sharing, health technology assessments, and step therapy (which requires patients to try certain, often less expensive medications before progressing to costlier drugs). This creates a potential problem, as delays in receiving health care, whether due to step therapy or other factors, can be detrimental to patient health outcomes.
Performance-based risk-sharing arrangements (PBRSAs) and value-based agreements (VBAs) have received attention of late because of the flexibility they give private payers, providers, and biopharmaceutical companies to better understand the value of new medicines and align payment with it. By tying payment to real-world outcomes, these arrangements—collectively referred to in this post as VBAs—have the potential to support patients’ prompt and affordable access to new, innovative treatments while also addressing payers’ cost concerns.
Despite considerable interest from stakeholders on both sides of the negotiations, there were few successful examples of VBAs in the U.S. until very recently: Between 1993 and 2013, there were fewer than 20 VBAs executed in the U.S. However, more of these arrangements have recently been announced, although they remain rare, and payers are expressing increased interest.
The academic literature provides information about some of the existing agreements and suggests possible barriers to their execution, but it leaves many questions unanswered. We conducted two-part interviews with a group of five stakeholders regarding their experience with these types of contracts. All respondents had direct experience developing and negotiating VBAs, four as representatives of private insurers and pharmacy benefit managers, and one on behalf of a large pharmaceutical firm launching branded products.
The interviews focused on respondents’ overall perceptions and expectations of VBAs, barriers to adoption, and possible solutions to those barriers (see note 1). In order to solicit unbiased responses, the interviews were double blinded: the sponsor of the research was not revealed to interviewees, and the identity of respondents is not known by the sponsor. We conducted the initial interviews during the summer of 2015 and followed up with the respondents this fall (2016) to understand how perception of VBAs and the barriers to them may have shifted.
Trump vs. Clinton: Voters divided over ACA but 66 percent favor public option
Respondents supporting the idea of the government providing an insurance option to compete with commercial plans could be swayed, researchers say.
Why Geisinger posts negative physician reviews
http://www.healthcaredive.com/news/why-geisinger-posts-negative-physician-reviews/429810/
Late last month, CMS updated its Overall Hospital Quality Star Rating program, its first update since July. In the update, 112 hospitals are now deemed five-star hospitals, up from 102 five-star hospitals in July but down from 251 in April 2015. As Becker’s Hospital Review noted, the October release includes updated data on patient experience, safety, effectiveness and timeliness of care.
The star ratings are related to patient satisfaction with care experiences based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures. The survey covers topics such as how well nurses and doctors communicated with patients, how responsive hospital staff were to patient needs, how clean and quiet hospital environments were and how well patients were prepared for post-hospital settings.
Opponents of the ratings have argued they oversimplify complex data and thereby convey misleading information that can harm reputations and reflect unfairly on certain hospitals. However, the move toward value-based care and transparency has led some healthcare organizations – such as Intermountain Healthcare and Geisinger Health System – to publish what patients think of them, for better or worse.
Patient stories have a greater impact on clinicians more than metrics like HCAHPS, Dr. Greg Burke, chief patient experience officer at Geisinger, told Healthcare Dive last week after a panel discussion on patient experience at U.S. News & World Report’s Healthcare of Tomorrow conference.
Geisinger serves more than 3 million residents throughout 45 counties in Pennsylvania. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians. It’s been in the news a bit lately due to its unorthodox move implementing its ProvenExperience money-back guarantee (It has refunded at least $400,000as of August). Burke stated that Geisinger posts about 97-98% of the comments it receives on the system’s clinicians.
Paul Ryan Makes Huge (Yet Really Obvious) Admission About Obamacare
House Speaker Paul Ryan (R-Wis.) hasn’t lost his grip on reality, he revealed Monday during an interview with conservative radio host Jay Weber.
Ryan admitted that a victory by Democratic presidential nominee Hillary Clintonwould mark the end of his quixotic quest to repeal the Affordable Care Act. That may seem like an obvious conclusion, but it qualifies as a noteworthy statement because it’s coming from the man who oversaw dozens of hopeless votes to overturn the 6-year-old health care law.
During the discussion on WISN, Weber laid out a series of “hard truths” with respect to the stakes in the presidential and congressional elections if Republicans fail to win the White House and lose the Senate, including Democrats being able to confirm Clinton’s Supreme Court nominees.
Here’s Weber and Ryan discussing the Affordable Care Act:
http://www.healthcaredive.com/news/ryan-accepts-aca-here-to-stay-if-clinton-wins/429898/
What the 2016 presidential election could mean for the future of the ACA
http://www.healthcaredive.com/news/2016-president-election-ACA-future-healthcare/429843/
At the federal level, the nation’s two major political parties have vastly different visions for the future of healthcare. The election will help to determine which course the nation follows for the foreseeable future. What are the likely outcomes depending on who wins the presidency?
HENRY KOTULA 