Report: Growing proportion of health care payments tied to value | Report: Managed care payers' admin costs rise with enrollment | Study: Urologists can help ACOs manage care of prostate cancer patients
October 22, 2018
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Report: Growing proportion of health care payments tied to value
The percentage of health care payments in the US tied to value instead of volume rose from 23% in 2015 to 34% last year, according to a Health Care Payment Learning and Action Network report. Nearly 50% of Medicare Advantage payments in 2017 were linked to value, compared with 38% in Medicare fee-for-service plans, 28% in commercial plans and 25% in Medicaid, according to the report.
Becker's Hospital Review (10/22) 
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Report: Managed care payers' admin costs rise with enrollment
An analysis from the Sherlock Company found that the administrative plan costs of managed care payers for staffing, customer service support and other items climbed by 5.7% last year driven mainly by a 7 million member increase in Medicaid enrollment. Roughly 7.1% of managed care plans' premium revenues went to administrative expenses in 2017 compared with 9.7% for commercial payers and 10.4% for Medicare plans.
Health Payer Intelligence (10/19) 
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Study: Urologists can help ACOs manage care of prostate cancer patients
Including urologists in accountable care organizations might reduce overtreatment of men newly diagnosed with prostate cancer, according to a study published in Cancer. Urologist input was not significantly associated with less treatment or lower spending in the first year after diagnosis, but it was associated with a lower potential for overtreatment in men who had a high risk of noncancer mortality, the researchers found.
The American Journal of Managed Care online (10/21) 
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Reps urge CMS to reconsider site-neutral payment rules
More than 130 House members asked CMS Administrator Seema Verma to reconsider applying site-neutral payment rules to more hospitals' off-campus outpatient departments next year, saying the expansion could slow hospitals' transition to value-based care models. Expanding the site-neutral payment policy is likely to result in lower revenue, hindering hospitals' ability to invest in new services and technology, the representatives said.
RevCycle Intelligence (10/22) 
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Insight into Health Care Quality
OIG: Giving doctors bonuses to boost screenings doesn't violate laws
The HHS' Office of Inspector General said providing incentive payments to doctors to raise the number of preventive screenings for Medicaid beneficiaries is not a violation of anti-kickback laws. The agency released the advisory opinion in response to a request by an insurer considering paying bonuses to physicians in its network to encourage early and periodic screening, diagnostic and treatment services for Medicaid members.
Modern Healthcare (tiered subscription model) (10/19) 
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Leapfrog to begin evaluating surgical centers
The Leapfrog Group said it will begin evaluating and grading safety and quality at up to 5,600 surgery centers, focusing on staffing, surgical outcomes and patient experience. CEO Leah Binder said the evaluations will address gaps in information about same-day surgery.
Kaiser Health News (10/16) 
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The Technology Component
Study evaluates effects of patient access to physician's notes
A new study has found that patients who were given access to their physicians' notes via electronic medical records and completed a final survey post-treatment trusted their doctors more and gained a more enhanced understanding of their illnesses and the treatments they undergo, according to the online journal Practical Radiation Oncology. The respondents were cancer patients at the University of California, Los Angeles, Jonsson Cancer Center who were undergoing radiotherapy in 2017.
Medscape (free registration) (10/17) 
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Population Health and Patients
Food insecurity common among Medicaid beneficiaries, report finds
A survey conducted by the Root Cause Coalition found that Medicaid recipients are more likely to face food insecurity challenges, such as inability to afford healthy food or enough food, compared with commercially insured Americans. Medicaid recipients are more likely to suffer from nutrition-related health conditions such as obesity and hypertension, so they may require additional support, including integrated dietary and health care services, to improve their health.
Health Payer Intelligence (10/15) 
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Study: Being unfit is major health risk factor
Cardiorespiratory fitness is associated with longevity and being unfit is as big a health risk factor as hypertension, diabetes and smoking, researchers reported in JAMA Network Open. "It should be treated almost as a disease that has a prescription, which is called exercise," said Cleveland Clinic cardiologist and study author Wael Jaber.
CNN (10/20) 
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Researchers examine effect of poverty on heart health in teens
Adolescents from low-income families were at a greater risk of developing heart disease and were more likely to be obese or to smoke than those from affluent families, according to a study in Pediatrics. Researchers evaluated data on 11,557 youths ages 12 to 19 and found that 22% of teens from low-income families and 26% of those from middle-income families were obese, compared with less than 15% of adolescents from high-income families.
Reuters (10/17) 
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Health Insurance and Accountable Care Provider Company News
Solutions Provider News
Making health care simpler for consumers
AHIP's Consumer Experience & Digital Health Forum Nashville delivers ideas to help build and implement CX and digital health strategies that will break down barriers, advance affordability, outcomes, and consumer satisfaction. Register before Oct. 31 and save.
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AHIP News
Pairing health plans with growth-focused financial partners
HSA Direct Members are potential financial partners that can help health plans expand and enhance their HSA products. For example, UMB Healthcare Services, an HSA Direct member, delivers HSA custodial services and white-label multipurpose debit cards to insurance carriers, third-party administrators, software companies, and financial institutions.
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Earn your PAHM® with AHIP's AHM250 course
AHIP's Academy for Healthcare Management makes it easier to gain career-driving professional credentials. To earn your Professional, Academy for Health Care Management (PAHM®) designation, register for Healthcare Management: An Introduction (AHM250). This comprehensive industry overview is the sole requirement to earn your PAHM®. Learn more about all 40+ online courses and webinars and where they can take you. Register today.
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