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ClinOps I.M.P.A.C.T. Summaries: Trends in Value-Based Healthcare - January 2019

Keeping Leaders Informed of Operational Trends, Entrants, and Developments that I.M.P.A.C.T. Value Based Health Care

 

 

 

JANUARY 2019 Issue - learn about the following Trends, Entrants, and Developments that I.M.P.A.C.T. and Contribute to VBHC:

 

1.    INFRASTRUCTURE:

 

How blockchain could make waves in healthcare

Blockchain is a technology that promises to disrupt the healthcare industry and how many physicians practice medicine. Blockchain, often associated with cryptocurrency and digital trading, is a cooperatively maintained repository for information. The technology enables multiple users to upload and share information to provide a single accurate collection of details using a blockchain database. Learn More.

 

A case for Clinical Intelligence

Machine learning and artificial intelligence will massively influence the way healthcare is executed in the years to come. This is true for diagnostics, for medical therapy, and for population health management. This issue of Insights will address numerous tough and exciting questions around regulation, the algorithm black box, and what does it all mean for care delivery? Learn More.

 

In 2018, interoperability remained just beyond the horizon

Another year, another set of draft frameworks and rules, app releases and APIs, and the healthcare IT industry still hasn't solved interoperability. And yet leaders spent so much time talking about it over the course of 2018, a year punctuated by moments in data exchange that felt big but failed to deliver the holy grail of industrywide interoperability. Learn More.

 

Top 10 healthcare innovations for in 2019

We take a look at some of the top 10 healthcare innovations which are transforming the sector. Learn More.

 

2.    MEMBER EXPERIENCE:

 

Five Ways to Improve the Member Experience

The patient-primary care doctor relationship is an important one that can span for decades, so helping members find a doctor who is a good fit and who meets the member’s health needs is critical.

To help its members find a physician who understands them, Pittsburgh-based Highmark Health developed a Doctor Match tool plus see four other ways payers are improving the member experience. Learn More.

 

What We Learned From a Year of Americans ‘Risking It’ Without Insurance

Their stories from the trenches reveal a broken health insurance system that is increasingly out of reach. We have spent much of this year talking to people who had weighed the health benefits against the financial burden of purchasing insurance. Most decided to risk it, betting that going without made more sense than paying for coverage. Learn More.

 

Amazon made another bold move into healthcare that went relatively unnoticed

Online retail giant's reach into the Medicaid market to take on Walmart among lower income customers could bring disruption soon. Learn More.

 

Health insurers look to digital tools to improve customer experience

Health insurance customers generally report poor experiences with their health plans. Only utility and internet and television service providers have worse customer service scores, and that's saying something. But health insurers say investing in digital tools and other technologies can help them fix this and give their customers a personalized, frictionless healthcare experience. Learn More.

 

Want to make patients better partners in their care?

Patient-centered care requires including their voices in care decisions. So the American College of Physicians has issued a series of principles designed to make those conversations more effective.

The four guidelines were developed by the ACP’s Patient Partnership in Healthcare Committee (PPHC), which includes patients, clinicians and pharmacists. The group surveyed patients and providers to build the principles, in addition to reviewing previous research. Getting patients more engaged in their care ultimately impacts patient outcomes. Learn More.

 

3.    PEOPLE:

 

Why Engaging Providers in Value-Based Care Will Be Even More Critical in 2019

Value-based care as a way of holding down costs while enhancing overall health outcomes is continuing to gain momentum. New reimbursement models—The Bundled Payments for Care Improvement (BPCI) initiatives and the mandatory oncology care model—and increasing MIPS rewards and penalties are gaining traction in the market.

But, according to the report Engaged Physicians: How to Align Performance Management for High-value Healthcare, provider groups and health systems are underprepared to excel under the latest models. Learn More.

 

Physicians ask developers to visit hospitals before building apps

Hospitals are increasingly letting app developers shadow clinicians, observe medical procedures and attend medical consults to gain greater insight into how hospitals operate and four things to know. Learn More.

 

Oprah Winfrey Says 1 Decision Separates People Who Achieve Success from Those Who Only Dream

According to Oprah (and others), it's also one of the hardest things to learn.

Success often springs from new: new opportunities, new ideas, new perspectives, new connections, new ventures ...Achieving what you want to achieve often requires embarking on a new journey, bridging the gap from here, where you are today, to there, where you want to someday be. But sometimes success can come not from adding something new but from eliminating something old such as…Learn More.

 

You Can Be a Great Leader and Also Have a Life

Tesla and Space X CEO Elon Musk tweets that no one changed the world working 40 hours a week. He rarely sleeps or sees his kids and had a famously public meltdown. Apple’s Tim Cook is on email before the sun rises. And billionaire Mark Cuban worked until 2 am launching his first business and didn’t take a vacation for seven years. These intense work styles are often celebrated as the only way to get to the top and be a super-productive leader. But does it have to be that way? Learn More.

 

4.    POLICY:

 

Midterm Election Results: 6 Ways Healthcare Could Change in 2019

When Americans voted in the 2018 midterm election, healthcare was a hot issue. So now that the Democrats will control the House and Republicans will have a greater majority in the Senate, will they attempt to address the healthcare issues Americans are complaining about? Learn More.

 

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

A district judge vacated a 2018 policy that enacted a 30 percent 340B reimbursement cut, arguing the policy exceeded HHS' authority to adjust hospital payments. Learn More.

 

Affordable Care Act to remain in place during appeals process

The judge's move staying his decision on unconstitutionality of ACA stabilizes the market, at least temporarily. Learn More.

 

Number of outpatient facilities surges as industry values more convenient, affordable care

The number of outpatient centers increased 51% from 2005 to 2016, a trend that shows no sign of slowing. It mainly comes down to two things: making services more convenient and more affordable. That strategy moves along the entire continuum of care for providers. It's front and center for their real estate strategy as well. We are seeing health systems look to decompress their main campus and look to move more services to an outpatient setting. Learn More.

 

Site-Neutral Payments for Hospital Clinic Visits Starting in 2019

CMS finalized a policy that will extend site-neutral payments to clinic visits furnished in hospital outpatient departments. The site-neutral payments aim to lower costs for the most commonly billed service under the OPPS. CMS reported that Medicare and its beneficiaries pay more for clinic visit services when they are furnished in the hospital outpatient versus physician office setting. Learn More.

 

5.  PERFORMANCE:

 

CMS hones value-based payments in 2018

Risk was the buzzword for healthcare quality and safety in 2018 as the CMS strongly pushed its value-based payment agenda. But the agency gave mixed signals about other patient-safety issues. Learn More.
 

Most NextGen ACOs won bonuses for Medicare cost savings in 2017

Medicare Next Generation accountable care organizations produced $129 million in savings for the CMS in 2017 while earning an average of $3.3 million each in bonuses for beating cost targets and meeting quality benchmarks, the CMS reported Friday. Of the 44 participants, 32 scored bonuses for 2017, compared with 11 of 18 participants, or 61%, in 2016, the program's first year. Next Generation ACOs saved Medicare $62 million that year. Learn More.

 

6.    AFFORDABILITY AND VALUE:

 

Secret weapon: UnitedHealth's Optum business is laying waste to old notions about how payers make money.

As major health insurers battle steep losses on the exchange market, UnitedHealth has leveraged its ace in the hole to stay out of the red: Optum. Entering the healthcare services market might just be the answer to offset risk-laden insurance products. Learn More.

 

Administrative, network costs doomed New York City health plan startups

Building a health plan from the ground up is difficult. And nowhere is that more apparent than in New York City, where outsized losses have already taken down two out of three startups that came onto the scene in 2014. The startups faced four central challenges: higher-than-average risk adjustment payments, large administrative costs, low revenue and high claims costs. Learn More.

 

Berwick to hospitals: Focus more on health, less on reimbursement

Dr. Don Berwick has pointed to research that illustrates the stark disparities in life expectancy among people who live just miles apart in the same U.S. cities. He said it's the obligation of providers to address these stark inequalities. "The causes of (health inequity) are not ours to accept, they are ours to change," he said. "If you want to improve health, you have to reduce inequity." Learn More.

 

The Great Moderation in healthcare spending continues

Here's something to cheer this holiday season: Healthcare spending last year grew at its slowest rate since 2013. The Great Moderation in healthcare spending, which began early in this decade, continues. There was good news almost everywhere you looked in the latest report from CMS actuaries, which showed 3.9% growth, down from 4.8% the previous year. Prescription drug spending rose just 0.4%, a second straight year of below-average increases after drugmakers' price-gouging spree of 2014-15. Spending growth at physician offices and hospitals slowed to a rate slightly above the overall national average. Spending on nursing homes and other long-term-care facilities increased at half the national average. Even patients' out-of-pocket expenses posted just a 2.6% annual growth rate. Learn More.

 

7.    COMMUNITY:

 

You’re homeless, but you have to leave the hospital. Where do you go?

In Seattle, there's a place--and it costs much less. Cities around the country are looking to programs like Seattle's as a model. Learn More.

 

OhioHealth and ChenMed Partner to Transform Primary Care for Underserved Seniors

Three new dedicated senior medical centers in underserved neighborhoods to improve access and health outcomes for at-risk Columbus seniors. Learn More.

 

Santa Clara health system and Optum tackle the most complex of complex populations

Santa Clara Medical Director Dr. Jeffrey Arnold and Optum's Teddy Shah share a model that addresses a 90 percent Medicaid population. Healthcare is asked to do a lot. In its quest toward value-based care, it must look at the whole person. It's no longer about treating systems. Providers must treat social and behavioral needs, housing, transportation, energy assistance, food insecurity and nutritional support. Learn More.

 

8.    TRANSFORMATION:

 

Why six trends are pointing to a revolution in healthcare

A variety of events in 2018 are setting the stage for changes in healthcare that revolve around growing interest in consumer health, representing a divergence in the way that the nation has treated health in years past. The move away from sick care to health preservation is built on six trends—and of those, a unifying theme is that the technological acumen and infrastructure is in place to support this shift. Learn More.

 

Insurers want to lead if CMS pilots payments for housing, social determinants of health

Health plans argue they are the best group to manage and receive funding from the CMS if it decides to pay for housing, transportation and other social determinants of health. HHS Secretary Alex Azar shook up the industry when he remarked last month that the agency is putting together a pilot model that would allow healthcare organizations to bill the CMS for providing services such as assistance with food and housing. Learn More.

 

Groceries and therapy, too? New mental health clinic opens in a Walmart store in Carrollton

Dallas area residents can now drop by a Walmart store in Carrollton to meet with a mental health professional.

The new concept — started by Boston-based Beacon Health Options — aims to make mental health care more convenient and approachable by opening clinics in high-traffic locations like retailers. The company rented a space in the store and began offering therapy there in November. Learn More.

 

               

 

 

 

 

 

 

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