We’re well into 2020 and healthcare continues to evolve, fast as ever. This month, we saw the emergence of new trends, some evidence that value-based programs are starting to mature and more. Take a look — what caught your eye in February?
National Policy News
- CMS’ direct contracting model could be a major shakeup for basic healthcare services and primary care, but one association thinks the shared savings rate should be higher. The National Association of Accountable Care Organizations is asking CMS to increase the shared savings rate of its primary care model from 50% to 75% and enhance transparency of its financial methodology.
- Health leaders say that value-based programs have made improvements to quality. But, unless financial incentives can keep pace, that trend could be coming to an end. That and more new data on how healthcare leaders are planning to thrive under risk-based arrangements are part of our new market study.
- The need for value-based programs to address social determinants of health isn’t news, but the way some health systems are partnering with community-based organizations could help to speed up effective care delivery for high-risk populations.
The future of CJR
- While the joint replacement bundle for hips and knees has been the most popular of the Medicare’s Bundled Payments for Care Improvement-Advanced program, providers are beginning to shift bundles for medical and chronic conditions. Provider selection of the joint replacement bundle plunged from 77 % to 22%.
- The Comprehensive Care for Joint Replacement model, which is scheduled to cease by the end of the year, could be extended in certain hospitals through 2023 per a proposed rule from CMS. The extension would help CMS to “further assess the cost & quality impact to lower joint replacement procedures” (per CMS Tweet).
Value-based programs starting to mature
- Accountable Care Organizations are the most popular form of value-based initiative. While they serve as a great way to move away from fee-for-service models, it’s important for leaders to remember that ACOs are just a step on the value-based journey, not the final destination. Rev cycle intelligence took a deeper look at the issue this month.
- American Heart Association/American College of Cardiology-awarded hospitals may be getting financially penalized for populations they serve rather than the quality of the care they are delivering. Findings are showing that federal incentives are not aligned with prevailing medical consensus on what constitutes appropriate cardiovascular care.
- Can consumer-generated data actually forecast health risks and outcomes? As more information about consumers’ buying habits becomes available, there are some ethical concerns arising about how and whether healthcare organizations can or should use the data.
- The payer-provider gap may become blurry, as insurer-owned clinics are emerging and competing against doctor groups and hospitals. Insurers are able to steer patients to owned clinics that may have more limited options than hospitals, but offer lower premiums.