Unbiased Analysis of Today's Healthcare Issues
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…
It appears that the answer is ‘yes’. Many studies by the Dartmouth Atlas team have shown that regions that spend more on medical care do not always get better outcomes. However, a recent paper by my Precision Health Economics colleagues James Baumgardner, Ahva Shahabi, Mark Linthicum, Seanna Vine, and Darius Lakdawalla as well as Chris Zacker…
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…
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…
Provider pay-for-performance initiatives aim to increase reimbursement to physicians and others who provide high-quality, low-cost care to patients. Medicare has two main programs for physicians to ahcieve these goals: (i) the Merit-Based Incentive Payment System (MIPS) and (ii) the Alternative Payment Models (APM). MIPS measures cost and quality for smaller physicians groups whereas APM requires…
In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures? A full list is below. Ambulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP)…
In short, no. That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals. Some background on the value modifier program. In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however: Practices with 100 or more clinicians were subject to upward, downward,…
Many programs–such as Medicare’s Hospital Value-Based Purchasing (HVBP) program–aim to reward hospitals with high quality through higher reimbursement and penalize hospitals with low quality through lower reimbursement. Will this approach be successful? A commentary by McMahon and Howell (2017) says that hospitals are not really unified entities but rather a collection of workshops. Thus, the…
“Value” is the latest trend in health care. However, how does value get integrated into reimbursement? One approach to tying value to prices is through and outcomes based contract (OBC) where the reimbursement for a drug will depend on the real world outcomes experienced by the relevant patient population. A study by Nazareth et al.…
Are physicians ready for value-based payment? That is the question a recent paper by Markovitz et al. (2017) attempts to answer. This question is not hypothetical as the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) requires physicians to choose between the current fee-for-service structure under the Merit-Based Incentive Payment System (MIPS) or…