ICYMI: Notes from the field for April 2019

DATE: 05/02/2019

Looking back at recent news, we’re seeing a lot of interesting tidbits — like the fact that value-based care may have finally reached its tipping point. In addition, the multiple recent announcements from CMS may be cause for optimism. What caught your attention in April?


Are we at the value-based tipping point?

  • The transition from fee-for-service to value-based care has been slower than predicted. Yet, some are beginning to speculate that we’ve finally hit the value-based tipping point. Are we closer to having healthcare organizations get paid for keeping patients out of the hospital?
  • A new study reveals that 94% of healthcare executive respondents believe that a more value-based approach to healthcare is the future, but are still struggling with how to operationalize it.
  • The Department of Health and Human Services launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk.


New from CMS

  • Despite dropout from the Bundled Payments for Care Improvement Advanced program, CMS still calls participation in BCPI Advanced robust. With the enrollment period for model year three now open, it will be interesting to see how the plan is maturing.
  • CMS Administrator Seema Verma acknowledges Americans are in “desperate need” of more affordable healthcare. CMS is soliciting advice on how it can allow insurers to sell coverage across state lines — which could be a boon for telehealth options.
  • CMS announced plans to increase plan choices for Medicare Advantage and Part D plans that will help support and increase services that “address social determinants of health for people with chronic disease.”

ACO status update

  • A culture in which staff, clinicians and administrators are all accountable for achieving quality and cost goals appears to be the hallmark of a successful Accountable Care Organization, according to a new analysis from Health Affairs.
  • The notion of higher downside risk appears to be a frightening one for ACOs, according to the study. When asked what they would do if required to take on more risk, more than half of ACOs said they would consider leaving the Medicare Shared Savings Program.

Data analytics in the news

  • Providers are most interested in using their data analytics skills to tackle financial problems and create a secure future for their organizations. Care quality is close behind, but providers are not very confident that their clinicians have the skills and cognitive bandwidth to leverage data to its fullest extent.
  • Health systems, insurance companies and vendors are all angling for data scientists with knowledge of common programming languages and machine learning development, an examination of the job market revealed.
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