911 Doesn't Need To Mean a Trip to the ED.

The Emergency Triage, Treat, and Transport, or ET3, pilot would empower EMS crews to treat patients at the scene of a call (sometimes with the help of telehealth) or take a patient to an alternative site like an urgent care facility or a doctor's office.

Are We Getting What We Pay For?

For all the talk about rapid increases in health care costs, we just might be getting better value for it. So say David Wamble, director of health economics at RTI Health Solutions, and colleagues in a recent Health Affairs article.

Heaps of Health Care Waste. In Washington State, They Are Sifting Through It.

A report from the Washington Health Alliance looks at 48 treatments, tests, and procedures identified by the Choosing Wisely campaign as having little clinical benefit in certain circumstances and, in many cases, the potential to cause harm.

With CMS Demanding More Accountability in the MSSP, Will It Be 'ACOs Overboard'?

For 169 ACOs, time is up to take on downside risk. This group-30% of all of those in the Medicare Shared Savings Program (MSSP)-are Track 1, upside risk-only ACOs and are nearing the end of their contracts with CMS.

Fred Hutchinson Report Plots The Nexus of Cost and Quality.

A report from the Hutchinson Institute for Cancer Outcomes Research is remarkable. Committing to transparency as a catalyst for improvement, 27 hospital systems and cancer centers across Washington State bare all in the first public report to integrate clinic level quality and cost data in oncology.

Altarum's MESA Turns High-Deductible Coverage on its Head.

The architects of Medical Episode Spending Allowance (MESA) benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices. MESA could catch on quickly, particularly with plan sponsors who have seen consumer-directed plan designs work against them.

CMS Opens Window for BPCI Advanced but Target Prices Are Still Behind the Curtains.

Medicare's new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Until CMS releases more detail on pricing targets and other not-so-trivial nuances, providers who jump in may be taking a leap of faith.

And with MIPS, we just don't know yet.

It may take a little while longer to ferret out whether MIPS is having CMS's self-described effect-to "drive improvement in care processes and health outcomes, increase the use of health care information, and reduce the cost of care." Already concluding that cost reduction is unlikely, Medpac recommended scraping MIPS altogether.

Why bundled payments are poised to take off.

CMS's Bundled Payments for Care Improvement (BPCI) Advanced program signals a willingness among Medicare providers to redesign care and take on risk. More than 1,500 hospitals and physician groups signed up-north of what was expected for a program that includes downside risk from Day 1. Commercial payers are watching closely.

Value-Based Care: 5 Not-So-Easy Pieces.

Here they are: Value-based care can't be done one slice at a time, new value-based models will take aim at variations in care, the patient may gain a stronger voice, the tail cold wag the dog, and value-based care will create haves and have-nots. Some predictability from the federal government would be welcome.

Three Turbulent Spots That Could Ground Value-Based Care.

Many of today's value-based care models trace their roots to the Institute for Healthcare Improvement's Triple Aim. Arguably, their sustainability may hinge on how true they stay to that trinity of improving population health, the patient experience, and per capita costs.

In Utah, Process Measures Are Winning Friends, Influencing Outcomes.

Choosing the right blend of quality metrics for each DRG is one of the many intricacies of Value-Driven Outcomes (VDOs), Utah's answer to the challenge of how to "do" value-based care. An initiative five years in the making, VDO matches indicators of quality to DRGs with substantial variation in cost within Utah's own system.

Now Might Be the Right Time To Kill Hospital Value-based Purchasing Program.

No real trends in quality improvement or cost savings have emerged, while mortality outcomes have remained flat. The program withholds 2% of hospitals' Medicare pay and redistributes most of it to high-performing hospitals. With so little money at risk, the program simply may not turn enough heads.

An Old-Fashioned Notion: Stand Behind Your Wares.

Experience from the field suggests that measuring the outcomes that underpin risk-based contracts is not always as simple as it sounds. There are many practical challenges to value-based contracts: administrative overhead, the intricacies of data collection and validation, and understanding how or why the data are relevant to the agreement.

As CMS Opens the Data Vault, Entrepreneurs Build a How-to-Use-It Guide.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.

A return to the dark days of unaccountable care?

The ACA forced the kind of accountability that had been mostly talk, with little action, for the better part of two decades. It set standards for the development of quality measures and, through more than a dozen programs, tied Medicare payments to performance on those measures and others related to readmission rates, safety standards, and patient satisfaction. What happens if it goes?

AMCP Seeks an End to 20 Years Of Confusion Over FDAMA Section 114.

The FDA never issued regulations to clarify the boundaries of promotion of pharmacoeconomic data, something it's been dragging its feet on for nearly 20 years. In turn, pharma companies, fearful of being penalized for off-lable promotion, have erred on the side of caution, hesitating to take advantage of Section 114.

Medicaid ACOs: Innovation Follows the Brave.

Applying the ACO framework to Medicaid runs head on into a stubborn challenge: the disproportionate impact of socioeconomic factors on health in the Medicaid population. Poor health outcomes in low-income populations are often exacerbated by unstable employment and housing, transportation difficulties, and lack of access to nutritious food.