ICYMI: Notes from the field for March 2019

DATE: 04/02/2019

Hot topics in March included new reports on the state of value-based care and population health, interesting bundled payment initiatives and constant change in healthcare.  Here’s what caught our attention—what’s been on your mind?


Value-based care: Tagged as the most significant and pressing topic in healthcare this year

  • Today’s Medicare Advantage plans are flourishing—the increased population of aging patients is high among the reasons why. “Over the last four years, Medicare Advantage enrollment increased by more than 30 percent, while the number of people eligible for Medicare grew by about 18 percent.” Other reasons for the growth: Innovative models from big insurers and upstarts alike that improve care for health plan members and drive revenue for payers as they look beyond fee for service.
  • Healthcare executives are experiencing significant roadblocks as they forge ahead into population health initiatives. The potential for financial loss remains the single greatest barrier to the implementation of population health, according to a new State of Population Health
  • A pioneering bundled payment program at the University of Texas that focuses on the condition or person level of care (rather than the procedure level) is showing early signs of success. Could this type of model have an impact on future mandatory programs?
  • The changing healthcare landscape
  • Payer and provider consolidation has been growing since the launch of the Affordable Care Act, but that consolidation has been accelerating in recent years. Managed Healthcare offers a look at the benefits this can deliver to healthcare consumers.
  • As hospitals face increasing pressure from nontraditional competitors, there’s been a push to partner with outside groups. Hospitals and health systems should consider which services or activities outside partners may be better positioned to provide for a competitive edge.
  • Payer motivation to explore bundled payments as a solution to rising healthcare costs remains high. CMS’ renewed interest in bundled payments includes the possibility of additional mandatory participation for oncology and other providers. A recent study from the Journal of the American College of Radiology looks at the rising adoption of digital breast tomosynthesis in oncology bundles.

New resources and reports

  • AHRQ is proposing to fund efforts to use data analytics to enable primary care providers to better prevent and manage chronic illness. Combined with a more effective use of social determinants of health data, the grant-funded initiative may help primary caregivers improve the health of high-risk groups.
  • Eligible Medicare Advantage health plans in all 50 states may apply for the health plan innovations being tested under the Value-Based Insurance Design model. Read the fact sheet to learn more about the innovations being tested in the VBID model for 2020.
  • CMS released its first annual report on provider participation in the quality payment program. There’s a lot to unpack in the report, but one statistic of note: 95% of clinicians under the Merit-based Incentive Payment System avoided a negative payment adjustment.