The Future of Value-Based Payment: A Road Map to 2030
The 2020s require a new strategy that moves from a short-term focus on testing new payment models to a long-term focus on expanding models that are most likely to generate substantial savings and improve quality. This white paper outlines a new direction for the federal government—primarily through the Centers for Medicare and Medicaid Services (CMS)—to chart over the next decade aimed at completing the transition to a health care system that pays for value and reduced health disparities, rather than high volumes of services.
The Future of Value-Based Payment
A decade of innovation and experimentation has failed to transform the health care system to one that pays for value rather than volume. It is now time to reconsider how value-based payment models can generate substantial savings and improve quality and health equity. Experts from the University of Pennsylvania, with input from a national panel of experts, reviewed the effectiveness of past payment reforms implemented by the Centers for Medicare and Medicaid Services (CMS) and made recommendations about how to accelerate and complete the nation’s transformation to value-based payment. This brief summarizes recommendations that provide a path toward widespread adoption and success of alternative payment models, producing better health outcomes for all Americans, reducing wasteful spending, improving health equity, and more effectively stewarding taxpayer funds to support other national priorities.
Does Collective Bargaining by Physicians Hurt Consumers?
Prices for health care services are a function of negotiations between insurers and providers—and both sides are always trying to gain advantages.
Safety-Net Hospitals After Medicaid Expansion
In states that expanded Medicaid after the Affordable Care Act (ACA), safety-net hospitals (SNHs) saw their operating margins improve and levels of uncompensated care decrease. But a new study finds that while SNHs were also able to scale up some safety-net services—such as inpatient psychiatric care—these changes did not translate into measurable improvements in quality.
Developing the eMedical Student (eMS)-A Pilot Project Integrating Medical Students Into the Tele-ICU During the COVID-19 Pandemic and Beyond
Joshua Ho, Philip Susser, Cindy Christian, Horace DeLisser, Michael J. Scott, Lynn A. Pauls, Ann M. Huffenberger, C. William Hanson 3rd, John M. Chandler, Lee A. Fleisher, Krzysztof Laudanski
Abstract [from journal]
The COVID-19 pandemic has accelerated the demand for virtual healthcare delivery and highlighted the scarcity of telehealth medical student curricula, particularly tele-critical care. In partnership with the Penn E-lert program and the Department of Anesthesiology and Critical Care, the Perelman School of Medicine (PSOM) established a tele-ICU rotation to support the care of patients diagnosed with COVID-19 in the Intensive Care Unit (ICU). The four-week course had seven elements: (1) 60 h of clinical engagement; (2) multiple-choice
...Micro-Costing in Health and Medicine: A Critical Appraisal
Xiao Xu, Christina M. Lazar, Jennifer Prah Ruger
Abstract [from journal]
Background: Concerns about rising health care costs require rigorous economic study to inform clinical and policy decision-making. Micro-costing is a cost estimation methodology employing detailed resource utilization and unit cost data to generate precise estimates of economic costs. Micro-costing studies have not been critically appraised.
Methods: Critical appraisal of micro-costing studies in English. Studies fully or predominantly employing micro-costing were appraised for methodological
...It’s Not Just the Money: The Role of Treatment Ideology in Publicly Funded Substance Use Disorder Treatment
Rebecca E. Stewart, Courtney Benjamin Wolk, Geoffrey Neimark, Ridhi Vyas, Jordyn Young, Chris Tjoa, Kyle Kampman, David T. Jones, David S. Mandell
Abstract [from journal]
Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that investigated attitudes and barriers toward MOUD. Most treatment organizations that we interviewed are adopting at least one MOUD, suggesting that Philadelphia exceeds the national average of
...Patient Experiences of Integrated Care in Medicare Accountable Care Organizations and Medicare Advantage Versus Traditional Fee-For-Service
Molly Frean, Christian Covington, Maike Tietschert, Hassina Bahadurzada, Jodi So, Sara J. Singer
Abstract [from journal]
Background: Health insurance design can influence the extent to which clinical care is well-coordinated. Through alternative payment models, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) have the potential to improve integration relative to traditional fee-for-service (FFS) Medicare.
Objective: To characterize patient experiences of integrated care within Medicare and identify whether MA or ACO beneficiaries perceive greater integration than FFS beneficiaries.
...National Shifts in Outpatient Care for Patients With Cirrhosis
As the U.S. enters the tenth month of the COVID-19 pandemic, it is hard to imagine a time when telemedicine was not a mainstay of health care delivery, particularly in the care of vulnerable patients. However, few studies have examined the scale of how outpatient care has changed at the national level, and whether the changes have been sustained beyond the early months of the pandemic.
Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children
Lucy A. Bilaver, Sarah A. Sobotka, David S. Mandell
Abstract [from journal]
Racial and ethnic disparities in the use of nine common autism-related services among Medicaid-enrolled children with autism spectrum disorder (ASD) were examined, distinguishing between school and other community-based outpatient settings. Using 2012 Medicaid Analytic Extract data, we identified 117,848 continuously enrolled children with ASD. Several racial and ethnic disparities were found, varying by geography. Black, Asian, and Native American/Pacific Islanders received fewer outpatient services compared with white children, but
...Using Nationally Representative Percentiles to Interpret PROMIS Pediatric Measures
Adam C. Carle, Katherine B. Bevans, Carole A. Tucker, Christopher B. Forrest
Abstract [from journal]
Purpose: This study's aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer
...Costs and Outcomes for Patients with Dementia in Medicare Advantage Plans
How do patients with Alzheimer's disease and related dementias (ADRD) fare in capitated Medicare Advantage (MA) managed care plans, compared to their peers in traditional Medicare (TM)? This question is increasingly important, as nearly one-third of beneficiaries now choose MA, and the human and financial cost of living with ADRD is substantial.
CMS’ Inpatient Psychiatric Facility Quality Reporting Program
Patients in inpatient psychiatric care are especially vulnerable to physical and psychological harm, but they have largely been excluded from efforts to monitor, understand, and improve quality of care. In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program to ease inpatient psychiatry into the norms and scrutiny that general hospital care has received for a long time.
Disruptions in Preventive Care: Mammograms During the COVID-19 Pandemic
Hummy Song, Alon Bergman, Angela T. Chen, Dan Ellis, Guy David, Ari B. Friedman, Amelia M. Bond, Julie M. Bailey, Ronald Brooks, Aaron Smith‐McLallen
Abstract [from journal]
Objective: To measure the extent to which the provision of mammograms was impacted by the COVID‐19 pandemic and surrounding guidelines.
Data Sources: De‐identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms.
Study Design:
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