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Valuing Value-Based Payment

Oct 16, 2017• 37

By ANISH KOKA, MD

The idea that payment should be linked to the value lies at the heart of most of the transactions we participate in on a daily basis. Yet, value based payment in healthcare has seemingly run into very rocky waters as of late. It is at this precarious time that stakeholders representing large employers and other purchasers of health care’ took to the Harvard Business Review to write in defense of value based payment reform. The authors pepper their article with cherry picked ‘successes’ of the value movement and urge the country to forge ahead on the current path. The picture that comes to my mind hearing this is of the Titanic, forging ahead in dark waters, never mind the warning signs that abound.

One of the authors of the paper – Leah Binder – is President and CEO of the Leapfrog Group – a nonprofit organization founded in 2000 dedicated to triggering ” giant leaps forward in the safety, quality and affordability of U.S. health care by using transparency to support informed health care decisions and promote high-value care”. This is a laudable goal, but it is very much predicated on the ability to measure value. A perusal of the Leapfrog group’s homepage notes a 1000 people will die today of a preventable hospital error.

The warning is explicit – choosing the hospital you go to could be the difference between life or death. I have spent some time in the past about the remarkably weak data that lead to an estimate of 400,000 patients dying per year in hospitals due to medical errors, but suffice it to say the leapfrog group subscribes to the theory that of the ~700,000 deaths that happen in hospitals per year, half are iatrogenic. With no exaggeration, I can say firmly that those who believe this are in the same company as those who believe the earth is flat. If the home page of the Leapfrog group, examination of their claims in their HBR article merits additional concern.

Trump Thinks He Just Blew Up Obamacare With a Stroke of the Pen. Did He?

Oct 14, 2017• 2

By STEVE FINDLAY

If you had illusions, or hopes, that the “Kill Obamacare” reality show starring Donald Trump would settle down to a dull roar, events of the last few days should blow those illusions out of the water.

You’ve heard the news by now and I won’t repeat it here. In addition to your favorite media outlets, see this analysis by ACA legal expert Tim Jost.

Trump has been true to his word and his warnings of the last few months—that if Congress didn’t repeal and replace the Affordable Care Act he’d resort to regulatory and executive branch action.

The words of the day (Friday, Oct. 13) are “sabotage” and “spiteful.” And I agree. But I’ll be curious to hear THCB readers’ views on these extraordinary actions by the President. Bear in mind that every independent analysis of the elimination of the CSR (cost-sharing reduction) payments and reviving long-dead association health plans indicates:

Six Assertions on Knowing the Unknowable Future of Healthcare

Oct 13, 2017• 4

BY JOE FLOWER

Some things never change. Joe Flower is one of those things. Pay attention. Joe was the keynote speaker at Health 2.0 Silicon Valley earlier this month. We’re excited to feature the text of his remarks as a post on the blog today. If you have questions for Joe, you can leave them the comment section. You’ll find a link to a complimentary copy of his report Healthcare 2027: at the end of this post. You should absolutely download and read it. And take notes.

The future. The Future of healthcare.  Here are the seven words at the core. If you take nothing else away from this, take these:

Everything changes.
Everything is connected.
Pay attention.

— Jane Hirshfield

We are gathered here on holy ground, in Silicon Valley, the home of the startup, the temple of everything new, of the Brave New World.

And healthcare? Healthcare is changing — consolidation, new technologies, political chaos, a vast and growing IT overburden, shifting rules, ever-rising costs, new solutions, business model experiments.

So when I say, “The Future of Healthcare,” what are the pictures in your head? Catastrophic system failure? The dawn of a bright new day of better, stronger, cheaper healthcare for everyone, led by tech? Do we have all the confidence of a little girl screaming down a slide? Do we just say in denial about the future and end up in a kind of chaotic muddling along?

Moving the Needle to Diversify Health Tech

Oct 12, 2017• 4

By SABAH PERVEZ AND ALYX STERNLICHT

There is a dire need for the health tech workforce to keep pace with the changing racial makeup of the nation. According to the Pew Research Center study, from 1960 to 2010, the percentages of Americans identifying themselves as Black, Hispanic, Asian, or “other” increased from just 15 percent of the population to 36 percent of the population:

Black: Increased from 10 to 12 percent
Hispanic: Increased from 4 to 15 percent
Asian: increased from 1 to 5 percent
“Other”: Increased from 0 to 3 percent

The Four Things Keeping Hospital CEOs Awake at Night This Year (Hint: Donald Trump Isn’t One of Them)

Oct 9, 2017• 19

By PAUL KECKLEY

The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) last week– “New Direction for the CMS Innovation Center.” It’s the latest chapter in the unfolding policy framework that will govern the health system for at least the next 3 years.

The RFI, which doubles down on value-based alternative payment models and consumer directed care, coupled with a proposed rule to cancel mandatory bundles by former HHS Secretary Price, the administration’s actions last week to weaken contraceptive coverage requirements in employer-sponsored health plans and Congress’ FY18 federal budget that include cuts in Medicare and Medicaid funding provide a sobering context for hospital and health system strategic planning. But hospital CEOs have adapted to the new normal from DC: uncertainty about the laws governing our health system is standard fare.

Last month, I interviewed 13 hospital CEO’s in preparation for their upcoming Board-Management strategic planning retreats. They lead organizations in 11 states with substantial differences in the scale, scope and strength of their operations and the dynamics in their markets. Two are academic medical centers, six are independent multi-hospital systems and five operate in multiple markets. When I asked “what’s keeping you awake at night” their answers were the same.

Sorry. Health Care Reform Can’t Wait for Quality Measures to Be Perfect

Oct 6, 2017• 28

By BINDER, MARCOTTE, FILDES and THOMPSON

There’s a debate in the United States about whether the current measures of health care quality are adequate to support the movement away from fee-for-service toward value-based payment. Some providers advocate slowing or even halting payment reform efforts because they don’t believe that quality can be adequately measured to determine fair payment. Employers and other purchasers, however, strongly support the currently available quality measures used in payment reform efforts to reward higher-performing providers. So far, the Trump administration has not weighed in.

The four of us, leaders of organizations that represent large employers and other purchasers of health care, reject any delay in payment reform efforts for the following three reasons:

Even imperfect measurement and transparency accelerate quality improvement. One set of measures often questioned is the Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety Indicators (PSIs) used by the Centers for Medicare and Medicaid Services (CMS) and others in value-based payment programs. These indicators measure surgical complications and errors in hospitals, which is critical given that one in four hospital admissions is estimated to result in an adverse event.

PSIs remain among the most evidence-based, well-tested, and validated quality measures available. CMS uses many in its value-based purchasing programs. Use and reporting of PSIs through AHRQ’s Medicare Patient Safety Monitoring System has measurably improved quality. For instance, CMS reported a reduction in inpatient venous thromboembolisms (VTEs) from 28,000 in 2010 to 16,000 in 2014, meaning that 12,000 fewer patients had potentially fatal blood clots in 2014.

In addition to using quality measures in payment programs and for quality improvement, making measures public is key to accelerating change. “If transparency were a medication, it would be a blockbuster,” concluded a multi-stakeholder roundtable convened by the National Patient Safety Foundation’s Lucian Leape Institute in 2015. The foundation’s report cited the Leapfrog Group’s first-ever reporting of early elective delivery rates by hospitals in 2010, which galvanized a cascade of efforts to curtail the problem and thus reduce maternal harms and neonatal intensive care unit (NICU) admissions. This was effective: The national mean of early elective deliveries declined from a rate of 17% to 2.8% in only five years.

Building Better Metrics: Immunizations and Asking the Right Question(s)

Oct 5, 2017• 14

By NIRAN AL-AGBA, MD

As policy experts cling to pay-for-performance (P4P) as an indicator of healthcare quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark. At first glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job. Unfortunately, the parental vaccine hesitancy trend is gaining in popularity. Studies have shown when pediatricians are specifically trained to counsel parents on the value of immunizations, hesitancy does not change statistically.

Washington State Law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85%) compared to states where exemptions rules are tighter. Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws. Immunization rates are used to rate the primary care physician despite the fact we have little influence on the outcome according to scientific studies. Physicians practicing in states with a broad vaccine exemption laws is left with two choices: refuse to see children who are not immunized in accordance with the CDC recommendations or accept low quality ratings when caring for children whose parents with beliefs that may differ from our own.

I’m 35 Years Old And I’m Realizing My Life May Be About to End. And I’m Panicking, Just a Little.

Oct 4, 2017• 4

By SCOTT RIDDLE

It’s been a while since I put a piece of writing in the public domain, but suddenly I have a lot to get off my chest, well my colon actually.

Just three weeks ago life was good. Correction. It was awesome. The newest edition to our family had arrived on Christmas Eve, joining his two sisters aged 5 and 3. A month later we were on a plane home to Sydney, having spent four great years working for Google in California. My beautiful wife had been working at a startup on NASA’s Moffett campus and was worried about finding something equally interesting in Australia, but she managed to land a very similar gig with an innovative logistics start-up in Sydney. We’d come back primarily to be closer to family, but also to pursue a dream of setting up a family farm in partnership with my parents — intended as a great place to bring up our three kids but also as a new sideline income stream. We’d spent every weekend scouring Sydney for areas that met our criteria (good schools, commutable, cost of land etc) and we were settling on Kurrajong in Sydney’s west. I was just getting into a training routine for the CitytoSurf run having done the Monteray Bay half marathon a few months prior.

I’m 35 years old.

On July 19th I went for what I thought would be a routine GP visit. In my mind it was primarily to re-establish a GP relationship in case my kids needed an urgent care visit (the practice is literally around the corner from our place). I’d also noticed a bit of unusual bleeding from, well, my back passage and very recently a change in bowel habit. I wasn’t alarmed by either of these symptoms but my GP was concerned enough to refer me for a colonoscopy. So began the roller coaster.

AARP Caregiver Quality of Life Challenge Winners Announced!

Oct 4, 2017• 1

By CHELSEA POLANIECKI AND TIFFANY HSIUNG

Roughly one out of every three people in the United States serves as a caregiver for a chronically ill, disabled, or aging loved one at some point in their life*. Not only do most caregivers dedicate a significant amount of time to these duties,

but they often also work full or part-time jobs to make ends meet. These stresses result in 40-70% of caregivers exhibiting clinically significant signs of depression*. Fortunately, there is an increasing focus on caregiver well being, and now, more than ever, innovation in caregiving has the opportunity to make real change and improve tens of thousands of lives.

The AARP Caregiver Quality of Life Challenge, supported by AARP , and administered by Catalyst @ Health 2.0 in partnership with Mad*Pow, aimed to find tech-enabled solutions designed to help caregivers identify as caregivers, find available resources to ease their burden, and connect with others who can build and strengthen their support systems.

The Challenge, launched at HxRefactored in June 2017, received over fifty applications, with solutions ranging from AI solutions to podcasts and mobile apps. Submitted solutions were judged by our panel of experts, and scored based on how innovative they were, their potential for scalability, the strength of their design, and the potential for impact in the caregiver community. Winners were announced live this morning at Health 2.0’s 11th Annual Fall Conference.
Continue reading…

CMS Should Play the Role of Virtual Group Matchmaker

Oct 3, 2017• 4

By MANU UPPAL and DAVID INTROCASO

In the 2018 proposed Medicare Access and CHIP Reauthorization Act’s (MACRA’s) rule, published earlier this year, HHS has again proposed to exclude two-thirds of physicians, or 900,000, from participation in the Merit-based Incentive Payment System (MIPS). MIPS was created under 2015 MACRA legislation to incent financially Medicare physicians and other Medicare Part B clinicians to improve care quality and reduce Medicare spending growth. HHS is choosing to exclude smaller-sized physician practices because, it is believed, MIPS reporting requirements place too high a burden on less resourced practices. However, MACRA legislation includes a “virtual group” provision that allows for solo and small group practices to partner in meeting MIPS reporting requirements. For technical reasons the Centers for Medicare and Medicaid Services (CMS) was delayed in implementing the provision. The first year in which providers can participate in MIPS as a virtual group will be 2018. Designed correctly, virtual groups offer substantial advantages that include greater MIPS participation, more competitiveness, higher financial reward and more opportunity for small practices to keep their independence.