The Department of Health and Human Services wants to test models that would pay drugs based on their clinical value as part of a new plan to tackle high prices. The plan released Thursday lays out several administrative tools the agency plans to take to address high prices. It also calls on Congress to adopt several reforms…
Decades in the making, the transition to value-based care may soon be complete. In June, Liz Fowler, the new deputy administrator of the Centers for Medicare & Medicaid Services (CMS) and director of its Center for Medicare & Medicaid Innovation (CMMI), suggested that CMS may soon require providers to be reimbursed based on patient outcomes. This…
When asked about government’s influence and impact on healthcare, I like to cite my friend, former Health and Human Services (HHS) Secretary Michael Leavitt, who says, “If you want to change healthcare you have to change Medicare.” Everybody else—the commercial insurers and the providers—will follow. But changing Medicare is hard. As we’ve seen, even with…
Social determinants of health (SDOH) are associated with increased Medicare spending per beneficiary in certain geographic areas, according to a study from the Journal of the American Medical Association. Addressing social determinants of health in these regions can potentially lead to reduced healthcare spending and better quality healthcare. The results show that Medicare spending was higher in geographic locations where…
Accountable care organization (ACO) growth has hit a snag again, with the COVID-19 pandemic impacting the number of ACOs in public and private contracts, according to a new analysis. The analysis published in the Health Affairs blog found that ACO growth has plateaued over the last couple of years, starting in 2019 when CMS introduced…
To advance value-based care, the Medicare Payment Advisory Commission (MedPAC) has suggested that HHS reduce its number of alternative payment models (APMs) now that it has lessons learned from a wide range of previous demonstrations. “Operating a smaller portfolio of more harmonized models, with more consistent parameters and clearer and more aligned incentives, should more…
Two influential advisory groups sent recommendations to Congress calling for a revamp of how health plans are paid in the lucrative Medicare Advantage program, culling how many models CMS tests and curbing high-cost drug approvals. By many measures, the MA program has been thriving. Enrollment and participation has continued to grow, and in 2021, MA…
To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously,…
A group of bipartisan lawmakers wants the Center for Medicare and Medicaid Innovation (CMMI) to be more transparent in its handling of value-based care models as the center continues a major overhaul of its demonstrations. The 24 lawmakers sent a letter to CMMI Director Liz Fowler on Wednesday seeking for more insight into the center’s…
The Biden administration is exploring making more payment models mandatory in the future as it implements a more patient-centric vision for value-based care. Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler detailed parts of this vision on Thursday during an interview with Health Affairs Editor-in-Chief Alan Weil. Fowler said voluntary models come with major…
