Unbiased Analysis of Today's Healthcare Issues
This is one of the fundamental questions in health policy in recent years. Quality can be measured in two parts. First, does quality improved for targeted patients? Second, does quality improve for non-targeted patients. The first question is relatively clear. One would think that quality would improve for the patients targeted by a pay-for-performance (P4P)…
The answer is ‘yes’ according to a paper by Borrelli et al. (2025). The authors use annual Medicare Star Rating health plan performance for Medicare Advantage-Part D (MAPD) plans over the past decade (2015 to 2024). They find that: For plans achieving at least 4 stars on the medication adherence measures, 70%-74% of them also…
How best can you design an outcomes based agreement (OBA)? What are the key factors to consider? Project IDEATE is a “cross-disciplinary collaboration between National Health Service (NHS) Wales, industry and academia” with the aim to develop and refine OBA models. This initiative is described in Burton et al. (2024). What were the key factors…
Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the…
This is the title of a new paper I have out today at JMCP with co-authors Shanshan Wang, Jaehong Kim, Slaven Sikirica, and Alexander Sandhu with the subtitle “An economic model measuring the impact of sotagliflozin among patients with heart failure and diabetes“. The abstract is below: BACKGROUND: Heart failure (HF) is among the leading…
While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations. Providers forego certain revenue for uncertain ‘bonus’ payments. “One…
Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., the selection pathway). Alternatively, hospitals themselves could have behavioral responses to the metrics and may improve quality of care in response to public reporting…
In the past, I have written about the Enhancing Oncology Model (EOM), including an overview of the EOM program as well as a more detailed review of EOM’s payment methodology. A new paper in JAMA Health Forum by Kocher and Adashi (2023) describes their perspective on the EOM program. First, they provide a nice overview…
Back in July, I provided an overview of the Enhancing Oncology Model (EOM). Today I build upon that post focusing largely on CMS’s EOM’s Payment Methodology. I use a Q&A format as well. What is the goal of EOM? According to CMS “EOM is a CMMI alternative payment model designed to advance health equity, promote…
That is the connection made between Medicare Advantage (MA) Star Ratings under the Quality Bonus Program (QBP) and Garrison Keillor well-known segment on the Prairie Home Companion in a recent paper by Teno and Ankuda (2022). To better understand this linkage, first recall the famous quote from Mr. Keillor: That’s the news from Lake Wobegon,…