The cystic fibrosis medication is plenty expensive, and the benefit for many patients may end up being pretty modest. A review by FDA staffers noted that Orkambi only offered a small improvement in lung function and did not compare as favorably when it came to decreasing hospitalizations or infections.
It’s value = quality + outcomes ÷ cost. CMS leads the charge, with dozens of programs and pilot projects that involve valued-based care. UnitedHealthcare boasts that $36 billion of the company’s spend last year involved some kind of value-based arrangement. Anthem is in the same ballpark. Seems like a growing trend.
Yes, it failed to uproot the volume and intensity incentives of fee-for service medicine. But P4P deserves credit for getting the world ready for today’s value-based payment by pointing out the absurdity of paying for all services irrespective of their outcomes.
The Affordable Care Act relies heavily on the success of this payment scheme. The idea of bundling the provider payments for an episode is more targeted and flexible because it is on a smaller scale, involving a given procedure or diagnosis and a smaller group of patients.
This old standby is given new life because the ACA makes providers more at risk. The capitated medical group might be the best response to the consumer’s need for a stronger connection to the health care system. Not all medical groups can handle capitation, but some do quite well.
This payment method isn’t really a stand-alone program but a concept and payment mechanism that can be used with pay-for-performance, bundled payments, or capitation. The government likes it. CMS put booster rockets on shared savings, and many payers are taking the cue.
Extending health insurance for the LGBT community is one thing, eliminating disparities in health care is another. The Supreme Court’s Obergefell decision is not an employment law ruling and, as such, does not explicitly address the obligations of employers, say some experts.
David Balto, formerly FTC
One of the purposes of health care reform was to create more competition, and the recent spate of acquisitions works against that.
Elliott Antman, MD
This knowledge won’t come cheap, as the system braces for new agents that could add another $42 billion to the nation’s drug bill.
The combination of a neprilysin inhibitor and an ARB rescued neprilysin inhibition from obscurity.