It is no surprise that the phrase “improve the quality of health care delivered to patients and create cost savings” appears at the top of the consulting company KPMG’s announcement of a recent survey on bundled payments. Cost and quality are the ham and eggs of health care policy, and they seem to pop up everywhere. Still, providers — especially hospitals, the vast majority of survey respondents — seem to find in the use of bundled payments genuine hope for cost/quality advances.

Hospitals see such schemes as the future — one that they are preparing for.

Mark Berg, KPMG’s head of strategy and transformation for health care and life sciences, says that “providers are generating anywhere between 15% and 60% or more of their revenues from risk-based methods, such as bundling. This is much more than even one year ago.” He adds that providers think “bundling can strengthen relations with physician groups.”

Perhaps, but there are also some areas of concern.

The biggest challenge in launching a bundled payment plan, according to 44% of respondents, is aligning physicians and hospitals.

One third feel that control of expenditures throughout the bundle poses the biggest problem; 18% worry about how to keep tabs on performance information.

The survey of 190 representatives of provider institutions was taken during a KPMG webcast last October.

As a provider, how much of your current revenue is risk-based, whether bundled, capitated, or any other payment method?

Where is your organization in making a move toward bundled payments?

Where do you see the largest challenge of bundled payments?

Source: “Why Are Bundled Payments So Attractive for Hospitals and Physician Groups?” October 4, KPMG.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.