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ICYMI: Notes from the field for November 2019

DATE: December 1, 2019

The year 2019 is beginning to wind down, but there’s no shortage of updates in bundled payments, policy and payment reform. Here’s what we found interesting in November—what’s been on your radar?

Bundled payments

  • The theory and thought behind bundled payments is that they are an effective way to improve care delivery and reduce costs, especially for some non-urgent surgical procedures. However, their potential to see widespread adoption faces roadblocks, especially as the healthcare field has yet to identify an ideal bundled payment contracting strategy. Greater transparency and standardization may be able to change that.
  • The proposed radiation oncology bundled payment model is facing challenges. Last month, key industry stakeholders voiced concerns about the program’s ability to reduce costs. In more dire news for the program, new research finds that the cost prediction model was not reliable for prostate cancer.
  • DataGen’s own Alyssa Dahl was featured in a recent article in Medical Economics. As the Bundled Payments for Care Improvement Advanced initiative faces a new milestone, the article examines if there’s still value to staying in the program.

Technology and transparency

  • The U.S. Department of Health and Human Services, along with the Department of Treasury and the Department of Labor, proposed regulations requiring group health plans and health insurance issuers to provide greater transparency in pricing and coverage by disclosing cost-sharing information to participants. While this could be a good thing for consumers, it’s likely to cause a number of administrative issues for providers.
  • Policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the “digital divide” that accompanies healthcare disparities. This is particularly true in areas with a higher than average population of people who are dually eligible for Medicare and Medicaid, highlighting the need to improve access to information for some of the most high-need patients.

Making the Oncology Care Model work

  • More private payers are following CMS’ lead and moving to two-sided risk and oncology practices are strategizing on how to navigate the shift. Ensuring there is a healthy amount of physician leadership and getting buy-in from oncologists will be critical to success.
  • As the prospect of taking on that level of risk becomes closer to reality, OCM participants are doing what they can to build on the investment they’ve made to succeed in the program.

Risk and payments

  • Good news in the world of ACOs: More Accountable Care Organizations in the Medicare Shared Savings Program are taking on risk for their performance. Recent results show that Medicare ACOs are saving money, continuing a trend that’s been growing in recent years.
  • CMS’ payment policies are pressuring hospitals to buy up physician practices to take advantage of the better reimbursement rates they receive for their sites of care. Unfortunately, this is creating some challenges for patients, as Medicare enrollees are paying more, since the shift in care settings is causing their bills to rise.
  • CMS also finalized a number of major policy changes that will take effect in 2020 and beyond — are you prepared to face these changes? Take a look at what is on the docket as you plan for the year ahead.