January 2017

Digital edition
Checking the process and outcomes boxes only goes so far. To improve health care quality in a sustainable way, some experts argue, it’s vital to look at the structure of care delivery.
After 25 years, the Healthcare Effectiveness Data and Information Set (HEDIS) is still criticized for focusing on process and taking up doctors’ time. But it has been incorporated into physicians’ workflow and may yet be instrumental in bringing about value-based care.
The health system is entering uncharted territory with this approach, and new rules might be needed to ensure the studies are credible.
Most insurers are wary about any data that comes from outside their plan and whether RWE can take root in non-integrated plans is an open question.
Requiring some patients with chronic conditions to try and fail multiple medications leads to complications and drives up costs, say many physicians. Insurers answer that the trial-and-error approach can be an important way to rein in costs.
The challenges include not overburdening physicians and fitting into an increasingly complex, multilayered informatics ecosystem. Artificial intelligence is a work in progress, but early adopters of gamification could get ahead of their competition.


Value-Based Tools
Outcomes-based contracting for drugs is ready for the mainstream. Before they jump in, insurers and pharma need to solve data puzzles and outcomes conundrums.
Neither providers nor health plans have had an incentive to manage post-acute care. That’s changing. Metrics and predictive analytics can help.
The new Merck drug could help stem the tide of hypervirulent C. difficile, but it’s expected to be expensive.