Serving the Value-Based Care Community | |
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Health Affairs | February 20, 2024
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There has been recent policy interest in improving the affordability and access of prescription medications, including efforts to reduce disparities in access for low-income and minority beneficiaries. For example, the Inflation Reduction Act (IRA) is being implemented in response to continued concerns about drugs affordability, with a focus on reducing the price of selected drugs paid for by the Medicare program. States have also implemented a range of policies for reducing the unit price of drugs, such as preferred drug lists and multistate purchasing collaboratives. Legislation is currently being considered by congressional committees focused on pharmacy benefit managers (PBMs) in terms of rebates, certain types of transparency, spread pricing, and fee models. These drug policies are unlikely to achieve their maximum impact if they are not integrated with care delivery policies. | | |
Accountable care organizations are calling on the feds to increase participation of long-term and post-acute care providers in ACOs and to better incorporate episodic-based payments. The recently released white paper highlights ways the ACO REACH Model and Medicare Shared Savings Program (MSSP) can be utilized to grow participation. “If CMS is to achieve its goal of having all Medicare beneficiaries in an accountable care relationship by 2030, then it must take steps to better include provider types less represented in ACOs, including SNFs,” said National Association of ACOs (NAACOS) Senior Vice President of Government Affairs Aisha Pittman. “We hope our recommendations spark attention to this area, because patients served by LTPAC providers deserve the higher quality, lower cost care we know value-based care delivers.” | | |
Fee-for-service reimbursement models have contributed to a fragmented behavioral health industry. Substance use disorder (SUD) providers are set to evolve current reimbursement models to alternative payment systems in 2024. Alternative payment models, which include risk-bearing, bundled payments and shared savings, offer a brighter future for the industry. But taking on risk and working with payers to develop alternative payment models requires strategizing and careful discussion with payer partners, industry insiders told Behavioral Health Business. | | |
The nursing home sector’s minimal participation in Accountable Care Organizations (ACOs) – largely because they have not found it lucrative to be in ACOs or have been sidelined within ACOs by other provider types – has resulted in a push for change. In a joint effort aimed at enhancing the integration of long-term and post-acute care (LTPAC) providers into ACOs, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) have released a set of recommendations, which if implemented could result in cost savings and quality improvements for nursing homes. These recommendations, recently shared with the Centers for Medicare & Medicaid Services (CMS), target policies to increase participation of LTPAC providers in ACOs, fostering improved patient outcomes and reduced Medicare costs. | | |
For operational efficiency, value-based initiatives need a scalable digital infrastructure that can handle multiple reimbursement models, including fee for service. Value-based care (VBC) models are designed to improve patient outcomes and reduce healthcare costs by proactively focusing on patient wellness. This preventive approach to individual and population care requires collaboration between patients, providers, payers, and other stakeholders, such as community-based organizations (CBOs) that offer wellness-related services. Payers benefit from VBC models because their emphasis on preventive care results in a healthier overall population and better management of chronic conditions, which reduces claims for prolonged and expensive treatments. Heart disease, diabetes, cancer, Alzheimer’s disease, and other chronic illnesses combined account for 90% of healthcare costs in the U.S., according to the Centers for Disease Control and Prevention. | | |
Upcoming Sponsored Webinars | |
VBCExhibitHall offers FREE educational webinars for those who are working in value-based care (VBC), or would like to learn more about VBC! We encourage people to attend the live webinars so as to have the opportunity to participate in the Q&A. However, if you are unable to attend, a link to the recorded webinar is sent to all who sign up. Please register using an accurate email address so that you can receive the link to join and to the recording. | |
An HCC V28
State of the Union:
The Key to Excelling at VBC in 2024
| February 29, 2024 | 1 PM EST | Top takeaways from the first month of the V28 phase-in period and practical changes that can be implemented to help organizations make smoother transitions | | |
Check back next week for more webinar announcements! | | |
Designing Equitable Solutions to Increase BCS Completions Across Diverse Populations | How health organizations can increase breast cancer screening completions by delivering equitable digital engagement solutions to overcome barriers across diverse populations | | |
All Roads Lead to Value-Based Care, Part 4:
Real-life Operationalization of VBC
| Examples of how value-based care is being put into practice in real-world scenarios, including successful VBC initiatives in hospitals and nursing facilities; the role of data analytics in implementing VBC | | |
5 Ways ACOs Can Boost Cost Control through APP Quality Reporting | Five areas where ACOs can segue their quality measurement activities into cost performance gains to lower total cost of care | | |
Establishing your Medicare Advantage HEDIS strategy for the year | Innovative and unconventional approaches to Medicare Advantage HEDIS strategy from real-world experiences. | | |
Check our our Webinar Archive to view past webinars on a variety of value-based care related topics! | | |
Third Virtual National Healthcare Transparency & No Surprise Act Summit | April 16 - 19, 2024 | Virtual | | |
APG Spring Conference 2024 |
May 29 - 31, 2024 | San Diego, CA | | |
On occasion, we showcase one of our solution providers in a 4-5 minute interview and ask them what they bring to the VBC Community and what sets them apart.
Today's guest:
| Roji Health Intelligence guides ACOs, healthcare and hospital systems, medical groups and networks, and their providers on the path to Value-Based Care. By providing technology and services, as well as premium expertise, Roji Health Intelligence aids organizations in building the foundations and infrastructure needed for improving patient outcomes, providing care that is cost-effective, and succeeding under risk-based reimbursement. Roji Health Intelligence values integrity in their relationships with their clients, and is dedicated to providing their clients with the very best guidance in the world of Value-Based Care. | | |
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