Humana: Value-Based Care Report

Physicians in value-based agreements with Humana are evolving and seeing results. This report details three key areas of data: prevention, outcomes and cost and payments for Humana Medicare Advantage individual members assigned to primary care physicians in value-based agreements.

Humana shares these results annually to spotlight physicians’ progress and to highlight how the company supports them helping their patients achieve their best health.

The full report can be viewed at this link.  

Measuring Patient-Reported Shared Decision-Making to Promote Performance Transparency and Value-Based Payment: Assessment of collaboRATE’s Group-Level Reliability

Shared decision-making (SDM) between clinicians and patients is a key component of patient experience, but measurement efforts have been hampered by a lack of valid and reliable measures that are feasible for routine use. In this study, we aim to investigate collaboRATE’s reliability, calculate required sample sizes for reliable measurement, and compare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey items to collaboRATE. CollaboRATE’s provider group-level reliability reached acceptable reliability at 190 patient reports, while the CAHPS SDM measure demonstrated similar reliability at a sample size of 124. The CAHPS communication measure reached acceptable reliability with 55 patient reports. A strong correlation was observed between collaboRATE and CAHPS communication measures (r ¼ 0.83). As a reliable measure of SDM, collaboRATE may be useful for both building payment models that support shared clinical decision-making and encouraging data transparency with regard to provider group performance.

The full article can be downloaded below.

This position paper, written by Hilary Daniel, BS, was developed for the Health and Public Policy Committee of the American College of Physicians July 2017.

Document includes Background and Recommendations from the American College of Physicians on Improving Health Care Efficacy and Efficiency Through Increased Transparency.

Bridging the Gaps in Personalized Medicine Value Assessment: A Review of the Need for Outcome Metrics across Stakeholders and Scientific Disciplines

Despite monumental advances in genomics, relatively few health care provider organizations in the United States offer personalized or precision medicine as part of the routine clinical workflow. The gaps between research and applied genomic medicine may be a result of a cultural gap across various stakeholders representing scientists, clinicians, patients, policy makers, and third party payers. Scientists are trained to assess the health care value of genomics by either quantifying population-scale effects, or through the narrow lens of clinical trials where the standard of care is compared with the predictive power of a single or handful of genetic variants. While these metrics are an essential first step in assessing and documenting the clinical utility of genomics, they are rarely followed up with other assessments of health care value that are critical to stakeholders who use different measures to define value. The limited value assessment in both the research and implementation science of precision medicine is likely due to necessary logistical constraints of these teams; engaging bioethicists, health care economists, and individual patient belief systems is incredibly daunting for geneticists and informaticians conducting research. In this narrative review, we concisely describe several definitions of value through various stakeholder viewpoints. We highlight the existing gaps that prevent clinical translation of scientific findings generally as well as more specifically using two present-day, extreme scenarios: (1) genetically guided warfarin dosing representing a handful of genetic markers and more than 10 years of basic and translational research, and (2) next-generation sequencing representing genome-dense data lacking substantial evidence for implementation. These contemporary scenarios highlight the need for various stakeholders to broadly adopt frameworks designed to define and collect multiple value measures across different disciplines to ultimately impact more universal acceptance of and reimbursement for genomic medicine.

The full article can be downloaded below.

Developing Open‑Source Models for the US Health System: Practical Experiences and Challenges to Date with the Open‑Source Value Project

The Innovation and Value Initiative started the Open-Source Value Project with the aim to improve the credibility and relevance of model-based value assessment in the context of the US healthcare environment. As a core activity of the OpenSource Value Project, the Innovation and Value Initiative develops and provides access to flexible open-source economic models that are developed iteratively based on public feedback and input. In this article, we describe our experience to date with the development of two currently released, Open-Source Value Project models, one in rheumatoid arthritis and one in epidermal growth factor receptor-positive non-small-cell lung cancer. We developed both Open-Source Value Project models using the statistical programming language R instead of spreadsheet software (i.e., Excel), which allows the models to capture multiple model structures, model sequential treatment with individual patient simulations, and improve integration with formal evidence synthesis. By developing the models in R, we were also able to use version control systems to manage changes to the source code, which is needed for iterative and collaborative model development. Similarly, OpenSource Value Project models are freely available to the public to provide maximum transparency and facilitate collaboration. Development of the rheumatoid arthritis and non-small-cell lung cancer model platforms has presented multiple challenges. The development of multiple components of the model platform tailored to different audiences, including web interfaces, required more resources than a cost-effectiveness analysis for a publication would. Furthermore, we faced methodological hurdles, in particular related to the incorporation of multiple competing model structures and novel elements of value. The iterative development based on public feedback also posed some challenges during the review phase, where methodological experts did not always understand feedback from clinicians and vice versa. Response to the Open-Source Value Project by the modeling community and patient organizations has been positive, but feedback from US decision makers has been limited to date. As we progress with this project, we hope to learn more about the feasibility, benefits, and challenges of an open-source and collaborative approach to model development for value assessment.

The full article can be downloaded below.  

The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation

By what measure should a policy maker choose between two mediums that deliver the same or similar message or service? Between, say, video consultation or a remote patient monitoring application (i.e. patient-facing digital health innovations) and in-person consultation? To answer this question, we sought to identify measures which are used in randomised controlled trials. But first we used two theories to frame the effects of patient-facing digital health innovations on – 1) transaction costs (i.e. the effort, time and costs required to complete a clinical interaction); and 2) process outcomes and clinical outcomes along the care cascade or information value chain, such that the ‘value of information’ (VoI) is different at each point in the care cascade or value chain. From the trials, we identified three categories of measures: outcome (process or clinical), satisfaction, and cost. We found that although patient-facing digital health innovations tend to confer much of their value by altering process outcomes, satisfaction, and transaction costs, these measures are inconsistently assessed. Efforts to determine the relative value of and choose between mediums of service delivery should adopt a metric (i.e. mathematical combination of measures) that capture all dimensions of value. We argue that ‘value of information’ (VoI) is such a metric – it is calculated as the difference between the ‘expected utility’ (EU) of alternative options. But for patient-facing digital health innovations, ‘expected utility’ (EU) should incorporate the probability of achieving not only a clinical outcome, but also process outcomes (depending on the innovation under consideration); and the measures of utility should include satisfaction and transaction costs; and also changes in population access to services, and health system capacity to deliver more services, which may result from reduction in transaction costs.

The full article can be downloaded below.  

Integrating Telemedicine Into Training: Adding Value to Graduate Medical Education Through Electronic Consultations

Lack of timely access to high-quality specialty care in the United States remains an enormous challenge, especially for uninsured and rural populations. Over 70% of federally qualified health centers reported barriers to specialty care for their patients, leading to diagnostic delays and poor health outcomes. A recent study found that 86% of referral coordinators in a community health center cited patient insurance as the most important driver of poor access to specialty care. The increasing pressure for primary care clinicians to manage complex patients in shorter visits may also incentivize over-referrals: The US referral rates doubled from 1999 to 2009. These trends, as well as an ongoing national emphasis on cost savings in health care, have led to a recent increase in the use of telemedicine. Learning how to utilize telemedicine has become more relevant for trainees preparing to enter the physician workforce. Integrating telemedicine into graduate medical education (GME) curricula provides an important mechanism for improving trainee education on value-based care and increasing access to specialty care.

The full article can be downloaded below.  

Rising Health Care Charges: A Red Herring in a Value-Based Health Care World?

Certainly, the current hospital charge situation in the United States is economically inefficient in terms of the distortions among charges and costs and reimbursement as it is inequitable in its negative financial effects on specific segments of American society. However, these problems will likely diminish in importance with the continued evolution of value-based health care forces and extended health care coverage, with providers increasingly assuming the total cost-of-care financial risk.  Changing reimbursements and a focus on improving short- and long-term health care outcomes, as well as patient safety, under increased financial accountability, will frame the real value equation for health care delivery across the United States.

The full article can be downloaded below.  

Interoperability: Do we have the value proposition upside down?

Dr. Doug Fridsma, CEO of the American Medical Informatics Association, has been working on the nuts and bolts of interoperability for a very long time. Prior to joining AMIA, he served as chief scientist at the Office of the National Coordinator for Health IT, leading management of the Federal Health Architecture and Standards & Interoperability Framework during the pivotal post-HITECH period.

Since then, Fridsma and his AMIA colleagues have been vocal proponents of a forward-thinking and creative approach to interoperability, with an eye toward the health system of the future – one fed as much by data from medical devices, apps and other consumer-facing technology as by the clinical elements of the electronic health records.

In a future driven by new types of patient-generated information and social determinants data, most of it coming from outside of traditional health systems, Fridsma says it's critical to think of interoperability not as a goal to be strived for, but as an ongoing process, driven by diverse stakeholders, that will continue to evolve and be reshaped by emerging developments.

Fridsma spoke recently with Healthcare IT News about some lessons learned from his tenure at ONC; what AMIA thinks about the proposed interoperability rules from 21st Century Cures; the importance of staying focused on achievable use cases for data exchange, why it might be useful to share first and standardize later, and what lessons can be learned from the APIs undergirding the World Wide Web.

The full Healthcare IT News article can be viewed at this link.  

Chasing Value as AI Transforms Health Care

Business leaders no longer think about artificial intelligence in terms of future impact—they’re seeing the impact today. AI is appearing in all corners of business, transforming the way companies operate. Health care is no exception.

Health care players are using AI to address significant inefficiencies and open up powerful new opportunities. These include everything from the delivery of remote health care services to the early diagnosis of disease and the hunt for new life-saving medicines. Today, the technology is incorporated into heart monitors, smart glucose pumps, and other recently FDA-approved diagnostic devices. Biopharma companies are already using AI to improve the efficiency of R&D; one notable example is through identification of better drug targets.

The ongoing rapid development of AI will trigger a major shift in the value pools across health care. This has serious implications not only for the industry’s four major traditional sectors—biopharma, providers, payers, and medtech—but also for consumers and technology companies. Boston Consulting Group has conducted an in-depth analysis of the potential impact of AI on health care, identifying two prospective scenarios for how value will shift among stakeholders. Under one scenario, much of the value unlocked by AI is retained by players in the four health care sectors and technology companies—while the second scenario sees much of the value flowing directly to consumers.

The full Boston Consulting Group article can be downloaded below.