Total System Value™ – A DYNAMIC APPROACH TO VALUE DEMONSTRATION
HEOR Ltd. have been working on an exciting new framework called Total System Value™. This episode of tHEORetically speaking features their CEO Phil McEwan and CGO Jeff Anderson to talk to us about this dynamic approach to value demonstration.
Accelerating the Rise of Value-Based Care
Enacting value-based care payment models has been a priority of payer and provider organizations in recent years, but the implementation has been uneven, with care centers serving underprivileged or vulnerable populations being left in the lurch. Helping close the gap is pivotal to reaching the US Centers for Medicare and Medicaid Services (CMS) goal of transitioning to value-based payment models for the majority of Medicaid and Medicare reimbursements.
Examining the Five Biggest Players in Medicaid Managed Care
With over 70% of Medicaid beneficiaries being enrolled in plans from managed care organizations (MCOs), managed care has become a major player in the American health insurance industry. A new article by the Kaiser Family Foundation (KFF) takes a look at five of the largest MCOs and how they are influencing the managed care landscape.
Biden Administration Rolls Back Limit on Short-Term Health Plans
The Biden administration and the US Department of Health and Human Services (HHS) have put forward a proposed rule that would set the limit for short-term health insurance to 4 months, reversing a Trump-era rule that gave them durations up to one year with the chance of renewal. Democrats derided these forms of insurance as “junk insurance,” noting that although they are cheap, they have poor coverage and are only meant to serve as a stop-gap measure.
UK Public Okay with NHS Data Storage with Some Reservations
The UK’s NHS generates massive amounts of real-world data (RWD) every day, but recently data security has become a concern. However, a recent survey found that 59% of participants feeling comfortable with the agency storing their data, although most (89%) felt it was important that the data was stored in the UK. A majority, however, do not feel comfortable with their data being processed using artificial intelligence (AI).
Exploring Health Disparities in Childhood Epilepsy
A recently published article in Clinical Psychology in Medical Settings finds that health disparities faced by children and youth with epilepsy (CYE) are poorly explored in the scientific literature. The authors of the paper noted that very few epilepsy studies actually focused on identifying health disparities, with even fewer focusing on CYE.
CMS Publishes Revised Guidance for Medicare Drug Pricing Negotiations
As the upcoming Medicare drug pricing negotiations approach, the US Centers for Medicare and Medicaid Services (CMS) have released a revised guidance that better outlines the process. Pharma companies and industry groups have been anxiously awaiting such clarification, but the new information has done little to quell their concerns.
Healthcare Costs to Jump by 7% in 2024
A report by PwC projects that healthcare costs will rise by 7% next year. The report was based on interviews with major payer organizations covering over 110 million patients in the US. Estimated increases in costs are attributed to labor shortages, rising drug prices, provider contracts, and more.
Tips for Managed Care to Approach Value-Based Care
The shift towards value-based care has the potential to benefit patients, providers, and payers alike, but it brings about unique challenges for managed care plans. In a new Managed Healthcare Executive article, learn more about value-based care payment models and strategies to apply them successfully in managed care organizations.
Study Finds Americans with Health Issues Sticking with Managed Care Plans
A recently published study in JAMA finds that sicker patients of advanced age tend to stick with managed care plans. This is a change of pace from recent years, when the industry was decried for preferentially selecting healthier patients. The study was conducted using Medicare enrollment data taken from 45,000 patients.
Examining the Challenges in Implementing Value-Based Care at Academic Medical Centers
A new report in Health Affairs Scholars looks into the challenges that academic health centers (AMCs) face in implementing value-based care models. AMCs provide care that exceeds that of non-AMCs, but features that help them excel may hinder value-based payment models. Key challenges they encounter are rigidity of workflows and the financial agreements they have with practitioners.
From Analysis to Action: Exploring Health Equity with Aletha Maybank
In a new interview with Nature, senior vice president and chief health equity officer at the American Medical Association (AMA) Aletha Maybank, MD, MPH, speaks about her work analyzing the processes underlying health disparities and how they can be targeted to promote better outcomes in marginalized populations.
Catching Up with the Latest from CMS
The US Centers for Medicaid and Medicare Services (CMS) has been busy over the past few months. In a new Becker’s Payer Issues article, learn about the 13 latest moves by the agency that you should know. The first is a new projection by the agency, which expects to see a 7.7% increase in payer spending this year, as well as a 2.1 drop in Medicare spending.
Wells Fargo Sees Opportunities in Managed Care Stock Sell-Off
A wave of stock sell-offs in the managed care industry represent a buying opportunity, according to analysts at Wells Fargo. The sell-offs were sparked by comments from UnitedHealth and Humana that noted an uptick in procedures covered by Medicare Advantage plans that were likely postponed during the pandemic.
Dr. Mandy Cohen Selected for Next CDC Director
Mandy Cohen, MD, has been selected by the Biden Administration to lead the Centers for Disease Control and Prevention (CDC) as its next director. Cohen, who lead North Carolina’s response to COVID-19, will take the helm in early July, according to the White House. She is succeeding the current director, Rochelle Walensky.
US Congress Wants CMS to Up Telehealth Usage While Cutting Payments
The US Congress’s Medicare Payment Advisory Commission (MedPAC) has asked the Centers for Medicare and Medicaid Services (CMS) to ramp up telehealth utilization while, at the same time, cutting the payment rates associated with it. The request comes as the post-pandemic status of telehealth looks uncertain with policy changes following the recent end of the COVID-19 public health emergency.
Financial Pressure on Healthcare Systems Continues to Mount
With labor costs rising, decreased demand, and supply chain issues cropping up across the board, health systems faced financial difficulties in the past year. This is expected to get more pronounced over the coming years, despite consumer inflation outpacing inflation in healthcare prices. Changes in patient usage are further contributing to cost increases.
Renting Associated with Worse Health Outcomes in Older People
According to newly published research, older people who rent have worse health outcomes than those who own a home. The study finds that older renters also are less likely to have medical cards, exacerbating their health costs. This issue is only growing more pressing as rising rent prices further sap the finances of older people who often live on fixed incomes.
CMS Projects US Health Spending in 2031 to Exceed $7.2 Trillion
In a study newly published in Health Affairs, authors use CMS figures to project US healthcare spending to exceed $7.2 trillion by 2031. This is based on an expected annual growth in spending of 5.4 percent by year. Although recent economic growth exceeded recent increases in healthcare spending, this trend is not expected to hold up long-term.
Atropos Health Shares Real-World Evidence Examining High vs Low-Cost Medications
In a poster session at this year’s American Society of Health-System Pharmacists (ASHP) meeting, Atropos Health presented real-world evidence examining the impact of prescribing high-cost vs low-cost medications on patient health outcomes. The study, which looked at electronic health records (EHR) taken between 2015 and 2021, found no difference in outcomes between drugs at different price brackets.
Talking Fast-Track Designation and Drug Development with Dr Courtney DiNardo
In a new interview with AJMC, Courtney DiNardo, MD, MSCE, of the University of Texas MD Anderson Cancer Center detailed how FDA fast track designation can help with the drug development process. She argues that it can help guide trial development in ways that align with agency preferences and priorities. In addition, she spoke about patient recruitment and retention.
EFPIA Calls for EU Digital Health Regulatory Harmonization
The European Federation of Pharmaceutical Industries and Associations (EFPIA) has released a report highlighting the need for harmonized regulatory requirements for digital health devices and apps. As it stands, only a few countries in the EU have standards for value assessment, reimbursement, and funding pathways. The EFPIA argues that this lack of harmonization constitutes a barrier to access for patients.
How New CMS Rules to Cut Appointment Wait Times Will Affect Managed Care
Research shows that new patients have to wait an average of 26 days for an appointment in 15 major US cities. To tackle this problem, the Centers for Medicare and Medicaid Services (CMS) recently proposed a rule entitled the Notice of Proposed Rulemaking Managed Care Access, Finance, and Quality (NPRM). The NPRM would cap appointment wait times for primary care, mental health, and substance use disorder treatment.
340B Eligibility Associated with Reduced Biosimilar Uptake
A recently published study in Health Affairs found reduced biosimilar uptake in hospitals in the 340B program, which provides drugs at reduced cost to certain care centers. The study examined nearly 600 hospitals using claims data, the Healthcare Cost Report Information System, and a 340 participation database. 340B-eligible care centers had a biosimilar usage rate that was 66% lower than non-eligible hospitals.
Three Strategies for Providers Implementing Value-Based Care
Value-based care models have been put forward as a solution for rising Medicare costs, paying providers for the value their care provides patients. New laws are further incentivizing adaptation of these payment models. To jump on board successfully, Edifecs published an article earlier this year covering three strategies to help providers take on value-based care models successfully.
