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Sustained value-based care program participation is needed if we are to realize greater quality improvements for high-need patients, according to a new  American Journal of Managed Care study. Cost and quality improvements in value-based care programs may take years to develop, and may require changes in the health system and patient behavior, say researchers. They remain optimistic: "Given the large investment in pay-for-value programs to date, and their growing prominence, our findings offer reassurance that these initiatives appear to be effective in accelerating performance improvement among primary care practices caring for high-need patients." ( Health IT Analytics American Journal of Managed Care )

Most (62.2 percent) health care executives believe payers should be required to pay for telemedicine services, according to  Managed Healthcare Executive' s 2017 Technology Survey.  Randy Parker of MDLIVE says the current fee-for-service approach hinders such reimbursement. "However, as the healthcare system transitions to the value-based care payment structure, telemedicine will become an affordable option for health systems and plans to meet or exceed incentive payment scoring outcomes, therefore allowing reimbursement to expand rapidly, according to experts." (Managed Healthcare Executive

OptumCare has agreed to acquire Surgical Care Affiliates for about $2.3 billion in a cash and stock deal. Deerfield, Ill.-based SCA owns or operates 190 ambulatory surgery centers and surgical hospitals, most as joint ventures with physicians and health systems. According to Modern Healthcare, the deal suggests that Optum, the health care arm of UnitedHealth Group, "is betting that any changes to the Affordable Care Act...will continue to provide coverage for the up to 30 million people it has insured." (Modern Healthcare )

Faster health spending growth in 2014 and 2015 (5.3 and 5.8 percent, respectively), combined with lower growth in the overall economy, resulted in a 0.6-percentage-point increase in the health spending share of GDP, according to a paper in  Health Affairs . "While the 2014-15 period is unique, given the significant changes in health insurance coverage that took place, health spending is projected to increase as a share of the overall economy over the next ten years and will be influenced by the aging of the population, changing economic conditions, and faster medical price growth," the authors conclude. ( Health Affairs )
Innovation & Transformation    
Research published in  Health Affairs makes the  case for incorporating social determinants into patient care and physician payment, citing Britain and New Zealand as examples of where physician payment is based in large part on levels of social risk among their patients. The authors explore these countries' deprivation indices and make the case the United States "desperately needs" its own. (Health Affairs; AFFP News )

A compact breathalyzer has been developed to allow diagnosis of up to 17 diseases by analyzing a patient's breath. The proof-of-concept device was found to be 86 percent accurate, researchers reported in  ACS Nano "Overall, these findings could contribute to one of the most important criteria for successful health intervention in the modern era, viz. easy-to-use, inexpensive (affordable), and miniaturized tools that could also be used for personalized screening, diagnosis, and follow-up of a number of diseases, which can clearly be extended by further development," they conclude. (Quartz ACS Nano )
Consumers & Providers
Patients may have trouble accessing their health data, but criminals don't. Millions of patient health records are stored together, which means criminals who breach the database have access to all the information, "We need to move on from the days of health systems storing and owning all our health data. Patients should be the owners of their own medical data. It's an entitlement and civil right that should be recognized." (The New York Times)
A provision of the defense appropriations bill may allow the Pentagon to test a private health insurance exchange pilot for reservists. The five-year pilot program would not necessarily operate through a website, but it would offer reservists and their families access to a wide range of national and regional health benefits plans. (LifeHealthPro )
New & Noted   
Burwell: Let Medicare negotiate drug prices:  Health and Human Services Secretary Sylvia Burwell recently called for giving Medicare the authority to negotiate drug prices. It's the best way to keep those spiraling costs under control, she argues. (Kaiser Health News )

Vaccine foe tapped:  President-elect Trump has asked vaccine critic Robert F. Kennedy Jr. to lead a new vaccination safety panel. Kennedy espouses the widely discredited belief that vaccines cause autism. (Kaiser Health News )

Cancer mortality rates drop:  Cancer death rates in the United States have dropped 25 percent since the early 1990s, according to the American Cancer Society's latest cancer incidence and mortality estimates. This is largely due to declines in the four major causes of cancer death--lung, colorectal, breast and prostate cancers. (Consumer Health Day )

Approving medical marijuana doesn't mean it's covered: North Dakota voters overwhelmingly approved the legalization of medical marijuana, but major health insurers in North Dakota say they won't cover medical marijuana, citing lack of evidence of effectiveness. (Daily Globe )

In this American Journal of Managed Care interview, Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive, explains why oncologists must recognize the importance of the patient voice when making treatment decisions so the treatment plan can be adapted to each patient's goals and desires. (AJMC )
MarketVoices...quotes worth reading
"Ideally, all public and commercial payers would see the value of telemedicine in reducing costs and improving patient health and reimburse telemedicine for medical and behavioral care across all geographies."--Randy Parker, chief business development officer for MDLIVE, quoted in Managed Healthcare Executive

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Wednesday, January 11, 2017