Value-Based Care Needs Only Five Quality Measures

4sight Health | August 2, 2024

I was the editor of a healthcare business magazine for 11 years. I was in charge of hiring and firing our editorial staff of reporters, editors and designers. My performance measures for new hires were pretty simple: get to work on time, work hard, do a good job, don’t cause any trouble and leave on time. You’d be surprised how many people said they could meet that five-part test if I hired them but who then had issues meeting one or more of those performance criteria after I hired them. We also had performance measures for our editorial staff as a whole. Metrics like corrections to measure our accuracy, letters to the editor to measure our reader engagement, scoops to measure our deadline performance against our peers and editorial awards to measure the quality of our work. But that’s nothing compared with the number of performance criteria facing primary care physicians (PCPs) in value-based care (VBC) contracts, according to a short but revealing research letter in JAMA Health Forum.

Researchers: ACOs Have Not Meaningfully Boosted Socially Vulnerable Patients

Healthcare Innovation | August 27, 2024

A research article by a team of researchers has found that the development of accountable care organizations—particularly of the ACOs participating in the Medicare Shared Savings Program (MSSP) has not in itself advanced the development of work on the social determinants of health (SDOH). That’s the conclusion of an article published in the July issue of Health Affairs. The authors—Dhruv Khullar, William L. Schpero, Lawrence P. Casalino, Reekari Pierre, Samuel Carter, Yasin Civelek Manyao Zhang, and Aelia M. Bond—write in “Meeting The Needs Of Socially Vulnerable Patients: Views Of ACO Leaders On Moving From Intent to Action”—that “The Centers for Medicare and Medicaid Services has placed growing emphasis on social drivers of health, but little is know about how accountable care organizations (ACOs) aim to meet the needs of vulnerable patients.”

Geisinger Health System: A Bellwether for Value-Based Care

MedPage Today | August 27, 2024

The COVID pandemic that overwhelmed our healthcare industry and laid bare the vulnerability of our systems is relatively well contained today. Now that we’ve moved beyond crisis mode, where is U.S. healthcare headed as a system? My hope is that we will return our attention to the health system’s transition from fee-for-service to value-based care (VBC). This entails expanding the implementation of care delivery and payment models that are aligned with “upstream” services (e.g., prevention and care coordination). The focus is on the quality of services, health promotion, access, and affordability. I will be the first to admit that VBC is still a work in progress and even the best-intentioned models may benefit from tweaking. That said, there are a few exemplary organizations. The one I know best - a true bellwether – is Geisinger Health System (Geisinger).

Improving Participation In Value-Based Care—The CMS Innovation Center’s Data-Sharing Strategy Initiative

Health Affairs | August 2, 2024

Data are essential to the Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation’s (CMS Innovation Center’s) mission to develop and test innovative health care payment and service delivery models. Accurate and comprehensive data can support model operations, including payment, enable the evaluation of model performance, and can be an important resource for model participants trying to transform care delivery. Additionally, one of the CMS Innovation Center’s goals is to test ways to better share data, with the aim of incorporating these lessons into other CMS programs, thereby improving the infrastructure of value-based programs.