Cigna Eclipses 50% In Value-Based Care Pay To Providers

Cigna says it’s paying more than half of its reimbursements to medical care providers in its top markets via value-based models that are quickly overtaking fee-for-service medicine in the U.S.

Value-based pay is tied to health outcomes, performance and quality of care of medical-care providers who contract with insurers via alternative payment vehicles like accountable care organizations (ACOs), a delivery system that rewards doctors and hospitals for working together to improve quality and rein in costs.

The full Forbes article can be viewed at this link.  

The value of learning health systems in disease control and aging

We are living in an unprecedented revolutionary age of science and technology. Real‐time databases of disease‐specific registries are expected to dramatically and efficiently accelerate clinical research studies. The use of real‐world data to augment data from randomized clinical trials is gaining traction and support globally. The article entitled “The Global Academic Research Organization Network: Data Sharing to Cure Diseases and Enable Learning Health Systems” in this issue describes the activities of the Global ARO Network, including a workshop with participants from Asia, Europe, and the United States. This network represents the global expansion of the ARO Council and global disease‐specific consortia that collaborate on disease‐specific registries. Such networks enable research on a global scale to test drugs and medical devices from academia, ushering in an age where we can collaborate on research and obtain approval for new therapies simultaneously around the world. The formation of global networks for patients with rare diseases is an essential step toward overcoming such diseases, and we now have a more specific picture of the expanded role that these networks play in realizing global learning health systems.

Not only can learning health systems be beneficial in identifying the best treatments for individuals with specific diseases, but there is a role for functioning learning health systems to be more broadly applied to identifying ways to prevent diseases by leveraging and learning from the data from healthy individuals. In developed countries, aging populations pose an increasing social burden and a threat to the vitality of the society, particularly when many of the elderly are inflicted with chronic or debilitating diseases. The slogan, “society in which people in their 100s can remain active,” presages a society where no one is bedridden.* This idea may seem like an impossible dream, like eternal youth and immortality. However, there is an important role of learning health systems in resolving the age‐associated dilemma of extending life, along with quality of life, and controlling diseases that prevent most elderly individuals from being independent and active centenarians.

The full article can be downloaded below.  

Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value

Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings.

We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013.

During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases.

The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.

The full article can be downloaded below.  

Value-based payment models are transforming a sizable portion of the U.S. healthcare economy by aligning provider compensation with improvements in care and cost controls. However, this shift in the way care is measured, billed and paid is far from complete or certain. Innovation and experimentation are ongoing, and a range of issues could slow or add costs to progress.

Professional culture, information security and healthcare quality—an interview study of physicians’ and nurses’ perspectives on value conflicts in the use of electronic medical records

Digital healthcare information systems impose new demands on healthcare professionals, and information security rules may induce stressful value conflicts, which the professional culture may help professionals to handle. The aim of the study was to elucidate physicians’ and registered nurses’ shared professional assumptions and values, grounded in their professional cultures, and how these assumptions and values explain and guide healthcare professionals’ handling of value conflicts involving rules regulating the use of electronic medical records. Healthcare professionals in five organisations in two Swedish healthcare regions were interviewed. The study identified ensuring the patients’ physical health and well-being as the overarching value and a shared basic assumption among physicians and registered nurses. A range of essential professional and organisational values were identified to help attain this goal. In value conflicts, different values were weighted in relation to each other and to the electronic information security rules. The results can be used to guide effective design and implementation of electronic medical records and information security regulations in healthcare.

The full pdf can be downloaded below.  

Healthcare Leaders on Unlocking the Value of Disruption: “Digital Innovation Needs to be a Strategic Priority”

Health systems are feeling the pressure from digital disruptors coming into the market along with the increasing demand to be more consumer-focused, noted one healthcare CIO during a recent healthcare innovation conference.

“We are going to be disrupted by Apple and Amazon, if we don’t change,” Adam Landman, vice president and CIO of Boston-based Brigham and Women's Hospital, said during a panel discussion at the FT Digital Health Summit in New York City last week.

At the same time, however, many forward-thinking healthcare executives see digital technology as a tool that can be leveraged to support value-based care with the aim of better patient outcomes at lower cost.

During the FT Digital Health Summit, sponsored by Financial Times Live, a panel of healthcare industry leaders, including Landman, along with Chet Robson, medical director, clinical programs and quality for Deerfield, Ill.-based Walgreens and Nelia Padilla, global lead, digital health at IQVIA, a company that provides technology solutions and contract research services, discussed the role of digital technology in achieving value-based care as well as the significant barriers to adopting digital solutions and the headway their organizations are making with digital innovation.

The full Healthcare Informatics article can be found at this link.  

Presentation slides and recording of 10/2/18 webinar.

Risk-based reimbursement contracts are the vehicle some health systems are using to move to value-based care, prompting health systems and plans to partner and share analytic tools.

On this webinar, speakers from Marshfield Clinic Health System and Milliman MedInsight discuss the top five tools they believe drive the success of their 6-year analytic partnership, which has helped mitigate risks and improve patient care.

By attending the webinar you will learn to: 

-Leverage predictive algorithms, benchmarks, and grouper technology
-Quantify cost reduction opportunities and utilization rates on potentially low value services 
-Use a cohort approach to fine tune care coordination programs for Population Health

Speakers:
-Michael Sautebin, Chief Actuary, Security Health Plan 
-Meghan Fetherston, Principal and Healthcare Analytics Consultant, Milliman

Financial incentives to encourage value-based health care

This paper reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to 0.5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared to other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared to using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.

The full paper can be downloaded below.  

Data is one of the most valuable assets in any organization and is necessary to sustain current and future business models. As healthcare transitions into a more analytically driven industry, managing data is especially relevant. Organizations are grappling with ways to manage continual changes in health information technology (IT), IT infrastructure, and the huge volume of data collected across the healthcare industry. The push toward value-based care has amplified the need for efficient exchange of quality patient data, which fills gaps in information and offers providers and payers a more complete picture of the patient. Data-centric strategies focused on managing the entire lifecycle of healthcare data are particularly important in today’s environment.

The policies and procedures to manage, protect, and govern information across a healthcare enterprise falls under data governance. Data governance includes data modeling, data mapping, data audit, data quality controls, data quality management, data architecture, and data dictionaries. A strong data governance structure is a critical component of any healthcare organization, as it provides a structure for analytics and other complex data initiatives.

In Spring 2018, eHealth Initiative Foundation and the LexisNexis® Risk Solutions healthcare business hosted the first in a series of roundtable meetings on data governance in healthcare. The meeting convened senior executives from stakeholder groups, including payer, provider, professional organizations, health information exchanges (HIEs), research, public health, laboratory, and pharmaceuticals. The goal of the meeting was to gather expert opinions on how to make data accessible, close quality gaps, turn insight into action, and protect sensitive patient information. This brief addresses the value of data governance in healthcare; existing challenges related to data governance; and key takeaways from the meeting.

A byzantine system of third-party payers, including insurers and government programs, keep consumers from understanding the true cost of their medical services, says Eli Lilly’s CEO.