Unbiased Analysis of Today's Healthcare Issues
“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…
The answer to this question must be ‘yes’. Everyone wants to see a good doctor compared to a bad doctor. However, what defines a “good” doctor? Patients perception of what makes a doctor good (e.g., bedside manner, clinic amenities) may not correspond to what technocrats or policmakers think (e.g., process of care measures). Even if…
An interesting editorial in JAMA by Schuster, Onorato and Meltzer (2017) makes the following point: So how should quality measures be prioritized? Many factors are currently considered, including a measure’s expected effect on patients and health care, potential for promoting improvement, scientific underpinnings, usability, and feasibility. But there is a major omission from this list:…
Why is it so difficult for health care payers to identify a “best” provider? A paper by Gutacker and Street (2017) explains: There are two key elements that complicate assessment of how well public sector organisations are doing their job (Besley & Ghatak, 2003; Dixit, 2002). First, they lack a single overarching objective against which…
David Augus and and Dana Goldman weigh in on Novartis’ decision to price their new chimeric antigen receptor T-cell (CAR-T) therapy known as Kymriah (tisagenlecleucel). The treatment represents ground-breaking technology, but is priced at $475,000 per treatment. But the authors note that there is something else novel about this technology: There was another announcement from…
That is the question that the Outcome Measures in Rheumatology (OMERACT) Working Group attempted to answer. Specifically, the working group aimed to determine the core set of outcome domains for measuring the effectiveness of shared decision-making (SDM) interventions within clinical trials used to treat rheumatic diseases. These diseases included osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic…
As part of Section 218(b) of the Protecting Access to Medicare Act, CMS instituted the appropriate use criteria (AUC) for the use of advanced diagnostic imaging. In order to be reimbursed for these diagnostic imaging services, physicians must consult with and document that they used AUC software before recommending advanced diagnostic imaging. Failing to document use…
Background Do pay-for-performance (P4P) programs work? P4P programs pay paying providers (or health plans) more if they have better outcomes or follow specific best practices. Whether or not they lead to better outcomes has been much debated. However, many P4P programs implemented in the real world have been evaluated using a pre-post design which could…
Please check out my latest publication in Value in Health titled “Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage“. This work is based on research conducted with my co-authors Jesse Sussell, Kata Bognar, Taylor T. Schwartz, John J. Sheehan, Wade Aubry, and Dennis Scanlon,…