The “waste-free formulary” under development by the Pacific Business Group on Health sounds promising, but ultimately may not deliver the impact to self-insured employers its creators are promising. The approach glosses over a critical question: What constitutes “high-value”? The definition of value plays a central role in determining the care that patients ultimately receive.
“Medicare for All won’t work unless we get rid of fee-for-service medicine—period, end of sentence,” says Dean. “Otherwise you’re wasting your time.”
Testing for biomarkers of acute kidney injury might help with treatment and prognosis. But there’s a lot of uncertainty about how useful it would be right now.
For organizations with a good strategy to reduce care variation, a hospital efficiency improvement program can provide the jolt of incentive that generates real improvement.
CMS continues to push on measuring and reporting information from the consumer perspective for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business.
Real-world data challenge assumptions regarding typical factor usage and expenditures associated with product switching in patients with hemophilia A. There were higher expenditures over two years on hemophilia A patients using extended half-life (EHL) versus standard half-life (SHL) products.
Britain’s National Health Service is taking a good look at how Americans do ACOs. But the move toward accountable care in England has already gotten mired in disputes (and confusion) about what organizational form it should take and whether current proposals are legal.
Because it enables both the security and sharing of data, blockchain seems ideally suited to health care. Next year, the pieces may come together for it to finally get some real traction in the sector.
Patient advocates say ‘fail first’ rules should be available online and decisions on physician appeals should be made within 72 hours–and in a day when it is an emergency.
The caveats: P4P programs don’t have a great track record, and avoiding risky patients may prove to be an unintended consequence.
Think of this alternative payment model as a large set of event-driven care packages that get triggered by consumer–patients. Each care package can be priced and adjusted for the individual’s medical history. Providers who want to bid for the care package can, and what they’re offering will be available and comparable to other providers.
Gene Farber, COO, Reliance ACO: “Reliance ACO is a Track 1 that started in 2014. We have saved CMS over $32 million and have received money back in two of the four years…. I want to scream when anyone, including Seema Verma, says we are not at risk.” There’s more.
Instead of relying on price comparison tools that insurers offer, patients instead will go where their doctors tell them to go to get MRIs, and in the process drive by an average of six other places where the procedure could have been done more cheaply.
But why? Trump administration wants credit for turnaround, but another take says it happened despite, not because of, the administration’s policies.