An AHIP report outlines three types of care models that it says offer coordinated care and address the unique needs of beneficiaries who are eligible for Medicare and Medicaid. Dual-Eligible Special Needs Plans, Medicare Advantage plans that normally offer both Medicare and Medicaid benefits, are poised to offer greater integration; Medicare-Medicaid Plans, which cover individualized care for each enrollee, are the newest and most integrated option; and Programs of All-Inclusive Care for the Elderly are designed to help elderly dual-eligibles remain in the community, rather than residential facilities such as nursing homes.
CMS Administrator Seema Verma said the agency will be unveiling new payment models centered on high-cost areas such as cancer, chronic disease and end-stage renal disease care as part of ongoing efforts to advance value-based care, and HHS Secretary Alex Azar said some of the models could be mandatory. The agencies noted health care providers can expect reduced regulatory burdens and more effective quality measures, but they must be willing to increase their share of risk.
The addiction recovery medical home model might be the next alternative payment model in the progression to value-based care, writes Matthew Fisher, chair of the Health Law Group at Mirick O'Connell. The model, developed by health care industry stakeholders, integrates payment reform, quality measurement, treatment and recovery teams, plans and networks, and the approach could have a positive ripple effect across the health care system, Fisher writes.
AHIP and eight other health care groups wrote a letter to CMS Administrator Seema Verma expressing concerns about proposed changes to the Medicare Shared Savings Program, particularly its plans to shorten the duration accountable care organizations spend in one-side risk models from six to two years and to reduce the shared savings rate from 50% to 25%. The proposals could deter participation, the groups wrote, adding that "MSSP remains a voluntary program, and it's essential to have the right balance of risk and reward to continue program growth and success."
Bundled provider payments that cover an entire episode of care, such as a joint replacement, appear to be promising for some treatments but need to be carefully evaluated. Robert Berenson of the Urban Institute said data on just one procedure does not tell much about the larger health care sector because much of health care is unlike replacing a joint.
Eight percent of 1,040 health plans received a top rating of 4.5 or 5 in the National Committee for Quality Assurance's health plan quality ratings report. Massachusetts, Rhode Island and Maine had the highest percentage of plans rated at 4.5 or 5.
Medical practices are advised to provide adequate EHR training for physicians, seek help from physicians in EHR development and clinical workflow design, and establish an EHR governance process, according to a white paper released by the Stanford University School of Medicine. The document also recommends presenting data in a user-friendly format, reducing clinician burden by offloading non-essential EHR tasks to other staff, and allowing patients to digitally maintain their EHRs.
An international systematic review found that general practitioners and hepatology experts often had difficulty discussing the seriousness of advanced liver disease with patients. Patients said they need better information about their conditions and that better coordination of care is needed to increase delivery of early palliative care, according to the study.
A study in JAMA Network Open showed that both body mass index and weight for length measures similarly predicted that children younger than age 2 who were overweight had increased odds of adverse cardiometabolic risk markers -- such as increased BMI z-scores, fat mass index, subscapular and triceps skinfolds, and waist circumference -- in early adolescence, compared with those who weren't overweight. However, the findings showed within-subject BMI measurements were associated with increased consistency over time, indicating that BMI may be more stable than WFL.
Learn how health insurance plans are using advanced data analytics and business intelligence to drive better care when you attend sessions in this track at AHIP's Consumer Experience & Digital Health Forum. Sessions will focus on objective improvements in clinical and quality outcomes, care management and financial performance. You'll also see how integrated systems help break down silos and deliver personalized experiences.
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