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Below are Intelligence Briefs available to anyone.
Evaluating Value-Based Care Part 1: An In-Depth Analysis of Federal Initiatives, Outcomes, and Promise for the Future
This brief, about Medicare’s VBC programs, is the first installment of a three-part series that will examine where the VBC movement is today, where it’s going, and how it can be reoriented to achieve greater success. It focuses on the results of Medicare Value-Based Care Programs, including the Medicare Shared Saving’s Program (MSSP) and CMMI demonstration projects. While the paper recognizes the shortfalls in VBC to date, it also points to opportunities and hope for the healthcare industry and the patients it serves as it continues to seek better outcomes at lower costs.
We are pleased to partner with Institute member Dr. Richard Walker and offer this timely intelligence brief which examines the value of value-based contracts in regard to health equity. Recognizing that alternative payment models don’t address disparities on their own, Dr. Walker affirms that attentive listening is the key countering implicit bias. Read more to understand the importance and potential impact from attentive listening!
The sections in this paper represent the core themes relevant to health value in 2022. These themes have been surfaced by the Institute for Advancing Health Value through research, weekly news review, and myriad conversations with industry. The bulleted items within each theme represent the most relevant developments and include links to the best articles for a deeper dive.
On December 1st, 2022, The Institute for Advancing Health Value hosted a virtual summit featuring leaders across the industry who are prioritizing equity in their value journey. The true goal of value-based care is to improve costs and outcomes for everyone, regardless of race, ethnicity, socioeconomic status, or any other factor. The Institute is committed to advancing health value and health equity through identifying, collaborating, and educating around the necessary competencies to achieve these aims. This document summarizes the key takeaways from each session.
The Healthcare Payment Learning & Action Network (HCP-LAN) virtually hosted their fall Summit on November 9th and 10th, 2022. The overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden.
This brief analyzes the 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently proposed changes to the program and the beginning of CMS’s new capitated total cost of care model, ACO REACH.
Previous Institute briefs describe the design of the GPDC model, compare the elements of this more advanced CMMI ACO model to the Medicare Shared Savings Program (MSSP), and analyze the organizations who participated in GPDC’s first Implementation Period (IP1) as well as those who elected to begin in April 2021. This brief builds on that series of GPDC/ACO REACH intelligence by considering the incoming final cohort of REACH ACOs within the context of the model’s history, analyzing the roster relative to GPDC’s current participants, and sharing expectations for the future.
This brief will 1) evaluate the promise of, and need for, health equity; 2) explain what lifestyle medicine is and why it is high- value care; 3) share how provider organizations can deliver lifestyle medicine both through their own processes and through community partnerships; and 4) present some of the challenges to widespread adoption of lifestyle medicine and how those challenges can be addressed.
April of 2022, the GTMRx Institute and the Institute for Advancing Health Value co-hosted an executive roundtable, Optimizing Medication Use for Accountable Care Success. The primary objective of the event was to facilitate discussion between value-based care leaders about the importance of optimizing medication use through comprehensive medication management (CMM) in practice through clinical teams working within alternative payment models (APMs). This report is a value-based care resource derived from the event and is open access once you complete the form.
This brief provides context for the proposed updates, details the rule’s major MSSP-related provisions, highlights industry reactions, and considers the implications of the changes to the landmark ACO program for current and prospective participants and the larger value movement. This brief is open access once you complete the form.
Risk adjustment is an important tool for providers, payers, and other healthcare stakeholders to understand and plan for the needs of a population and is fundamental to delivering value-based care. This brief outlines use cases, reviews commonly-used methodologies, and describes expectations for the future of risk adjustment.
Thank you to our sponsor, 3M
On February 24, 2022, the CMS Innovation Center announced a redesign of the controversial Global and Professional Direct Contracting Model and the launch of a replacement initiative, termed the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. The application period for this new model – set to begin on January 1, 2023 – opened on March 7, 2022. This brief will help you understand the key changes, new provisions, and potential implications of this revised model for your next step in value.
Thank you to our sponsor, Lumeris
The 2021 Health Care Payment Learning & Action Network Summit provided insight and thought leadership from CMS and others who champion value in health care. This brief summarizes the discussions and the results of the latest Measurement Report for reporting years 2019 and 2020, charting slow but steady progress in the adoption of alternative payment models.
Women make up the vast majority of the health care workforce but are underrepresented in positions of leadership, especially amongst physicians. The differential impact of choices and sacrifices that accompany the profession of medicine are not equitably distributed between men and women. Read this brief to learn more about the value imperative for equity in health care staffing and delivery.
With new leadership, many CMS alternative payment models are coming under intense scrutiny, including the MSSP. Data for the most recent year characterize 2020 as the most successful year for the program, in terms of net savings. This brief describes characteristics associated with ACO success in the MSSP and details a number of implications for the future of the program.
In theory, recent regulations from HHS promote accessibility of price information from hospitals that should aid in comparisons across facilities. The reality is not so clear-cut. Read this brief to learn more about how you might harness hospital price data to inform your value strategies.
Accountable care organization (ACO) models have been the Center for Medicare & Medicaid Services’ (CMS) primary vehicle for value transformation since the start of the movement. Under an ACO model, coalitions of providers agree to assume responsibility for the cost and quality outcomes of a defined population of patients. This brief is a comprehensive evaluation of both the direct contracting and MSSSP risk-based options.
In April 2019, the Centers for Medicare & Medicaid Services (CMS) announced a series of primary care-focused payment models designed to test various approaches to transforming primary care payments to reward value. Called the CMS Primary Cares Initiative, the Innovation Center (CMMI) will test five new payment model options under two paths – Primary Care First and Direct Contracting – each building on existing CMMI models to advance and expand effective elements of value-based payment programs.
Digital health technology is emerging as an imperative in value-based care delivery models. For reasons including safety, geography, patient convenience, and others, digital health apps are gaining in volume and popularity in the market. This brief will keep you apprised of current and future trends in the digital health landscape.