When is physician failure a good thing?

How do physicians learn?  A paper by Van Gestel, Muller, and Bosmans (2018) claims that the answer is through cumulative experience, economies of scale, or human capital depreciation. Learning from cumulative experience refers to the idea that treating an additional patient generally improves physician (or team) performance. When referring to economies of scale, we capture…

Will Medicare Advantage be the future of Alternative Payment Models

CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage).  Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…

The Status of Outcomes-Based Contracts

Outcomes-based contracts are supposed to be the next big thing.  When payers are not sure about the real-world benefits or cost of a treatment, outcomes-based contracts and help them diversity risk. For instance, CMS will only pay for the CAR-T product  Kymriah when “…these patients respond to Kymriah by the end of the first month…

Why hasn’t public value reporting led to more patients choosing high value care?

CMS has a number of quality initiatives to measure provider quality.  For instance, there is the Hospital  Inpatient Quality Reporting Program, the Home Health Quality Reporting Requirements, the Skilled Nursing Facility (SNF) Quality Reporting Program, the Inpatient Rehabilitation Facilities (IRF) Quality Reporting Program (QRP), among others.  Have these initiatives led to more patients choosing high value care? …

Outcomes-based pricing for Cardiovascular Disease

An interest Health Affairs blog post on outcomes-based pricing from Daniel M. Blumenthal Samuel Nussbaum Neil J. Weissman and Mark Linthicum. Insurers are increasingly tying health service payments to clinical outcomes to improve care value and quality. Outcomes-based pricing—setting treatment reimbursements to reflect their prospectively determined value to patients and the health care system—is a promising alternative payment…