Is the hospital readmissions reduction program bad for patients?

The answer is ‘perhaps’ according to a new paper by Wadhera et al. (2018). They use data from 2005 to 2015, and apply an inverse probability–weighted 30-day and 45-day post-discharge mortality measure stratified by whether there was an associated readmission. They examine admissions for acute myocardial infarction, heart failure, and pneumonia. Among Medicare beneficiaries, the HRRP…

90% of health plans think the use of alternative payment models will increase in the coming years

A recent report from the Health Care Payment Learning and Action Network (HCP LAN) examines how providers are getting paid in the U.S. today.  Traditionally, health care providers (e.g., physicians, hospitals) were paid via fee-for-service (FFS).  Fee-for-service means that every time a provider does a service, they get paid.  This is truly largely regardless of…

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…

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…