Unbiased Analysis of Today's Healthcare Issues
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…
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…
An interesting article in Modern Healthcare reviews some discussion at a recent Medicare Payment Advisory Commission (MedPAC) meeting. The first issue is that the pool of fee-for-service Medicare beneficiaries is shrinking, at least on a relative basis. As Medicare Advantage grows each year, population-based alternative payment models like accountable care organizations are left with a…
Tomorrow, Monday, May 18, I will be moderating a panel with Dr. Bapu Jena of Harvard University, Elizabeth Oyekan of PRECISIONvalue and Michael Barr of National Committee for Quality Assurance (NCQA). The topic is: WILL ALTERNATIVE PAYMENT MODELS INCENTIVIZE HEALTH SYSTEMS TO PRESCRIBE HIGH VALUE MEDICATIONS AND SUPPORT BETTER CLINICAL OUTCOMES? ISSUE:Recent decades have seen…
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…
That is the question that Carroll and co-authors try to answer in their latest NBER working paper (WP #23926). They examine the Arkansas Health Care Payment Improvement Initiative (APII), which is a state-wide, multi-payer episode-based program. Unlike most episode-based payment (EBP) models, provider participation in the program was mandatory (as of 2013). NBER summarizes the program…