At first patients didn’t care that much. Then the monitors improved, and studies showed improved outcomes. But CMS wouldn’t cover them unless they had a ‘nonadjunctive’ indication. Now some envision a time when fingersticks will be a thing of the past for many people with diabetes.
Price transparency mandates are catching on. But they may codify that which hasn’t worked all that well so far.
Integrated care models can foster the kind of collaboration that’s needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers that has caused so much suffering and early death.
An age/sex/gene expression score helped to identify patients with low current likelihood of obstructive coronary artery disease. These patients had lower costs of CAD care during one year of follow-up. Early reductions in cardiac referrals at 45 days among these patients persisted for one year.
The authors of Understanding Value-Based Healthcare provide this rationale for their book in terms of how to go about improving health care: “Government cannot do it. Payers cannot do it. Regulators cannot do it. Only the people who give care can improve it.”
For some, it might be more convenient—and it’s less costly. Why don’t more patients give peritoneal dialysis a try?
The pay-for-value movement could justify rewarding—and punishing—doctors based on quality scores. Problem: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Medicare’s Merit-based Incentive Payment System (MIPS) will clear things up. In fact, it might cause more confusion.
Community Servings, a not-for-profit organization in the Boston area, delivers medically tailored meals that take into account the nutritional needs of people with chronic illnesses. The idea is to ensure that a patient’s food addresses his or her specific health conditions.
Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.
Partnerships between hospital systems and retailers offer telehealth kiosks. Hospitals hope to find loyal patients, and the retailers see a chance to boost sales.
Care managers can quickly assess clinical complexity and monitor members climbing the cost and risk curve if they are armed with up-to-date information about a member’s medical and behavioral diagnoses, prescription medications, physician office visits, emergency room visits, and hospitalizations.
The FDA’s work to redefine ‘truthful and non-misleading’ communication may preempt state efforts.
Despite standardization, advocates for various industries and certain patient needs continue to propose changes in coverage rules. Much of the advocacy is occurring at the state level with a focus on pharmaceutical coverage, such as equalizing cost sharing between oral and infused oncology drugs or setting limits on cost sharing for prescriptions.
Geisinger’s goal is to be not just one of the top health care organizations, but one of top organizations among all the companies in the United States.
Companies that negotiate for better prices on specialty drugs without the incentive of discounts and rebates.