As the dual eligible demonstrations enter their fourth year in some states, reports on lessons learned from the programs thus far continue to emerge. The Center for Health Care Strategies (CHCS) issued such a report based on the lessons learned specifically by fourteen plans that are part of the Association for Community Affiliated Plans (ACAP) and are participating in the demonstrations. Highlighted in the report are lessons learned related to identifying unmet needs, care coordination, addressing the social determinants of health coordinating behavioral and physical health, engaging providers across the continuum of care and alternative payment models.
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule on Accountable Care Organizations (ACOs) that addresses some provider concerns about the model. According to the rule, CMS will use regional rather than national health care spending data to determine ACO shared savings payments beginning in 2017. Additionally, CMS gave ACOs in non-risk based contracts a one-year extension before they must enter into contracts that penalize them for not reaching savings benchmarks. While some provider groups remain concerned, these rule changes could encourage new providers to join the shared savings program under Medicare and help to retain providers who are already participating.
Providing consumers with more detailed information about the price of the health care they’re using has long been touted in some quarters as the key to reducing health care spending. However, as detailed in a recent New York Times article, the limitations of price transparency as a driver of consumer behavior are emerging, and those limits highlight what consumer advocates have said for years – people don’t shop for health care the way they shop for televisions or other consumer goods. Even as web-based tools that provide price information become more readily available, without corresponding quality information, for example, it remains difficult for consumers to use pricing information effectively.
NEJM Catalyst has taken a look at one hospital’s experience with the Medicare bundled payment program for joint replacement and found both clinical and financial improvements. They’ve also identified the key factors in successfully designing care for bundled payments. Also, the Alliance for Home Health Quality and Innovation has released a new data analysis on the bundled payment program and found that the use of home health after a hospital stay is associated with cost–effective care and lower readmission rates for Medicare patients who have undergone joint replacement surgery. These findings were used as the basis for a recent call by from health and financial experts, including former administration officials Don Berwick and Perter Orszag, for CMS to initiate more mandatory bundled payment demonstrations. The group suggested that cardiac procedures are promising candidates for bundled payments.