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Earler this month, the Obama Administration released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year. Meanwhile, the exchange market faces instability. Recent Avalere analysis finds that more than one-third of rating regions may have only one insurance carrier participating on the exchange in 2017.
CMS released another mandatory bundled payment proposed rule which will significantly expand the scope of hospitals bearing risk for episodes of care nationally.
Recently we examined the various models of specialty pharmacy integration/ownership and how they result in different care coordination dynamics and access to drugs. Our findings demonstrate real value and opportunities in linking medical and pharmacy data to better support the patient journey with services and tools.
Shifting to a value-based purchasing (VBP) system provides opportunities to engage payer and provider customers in unique contracting and reimbursement relationships that may optimize market access.
One year after Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in a landslide, the Department of Health and Human Services is implementing this legislation to transform physician payment.
With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.
Avalere hosts a series of webinars on “Navigating the New Dynamics of Outcomes Contracting and Risk Sharing Arrangements”. While traditional rebating and discounting terms have been a staple of industry contract negotiations, a new strategic focus is emerging on additional modes through which overall value can be measured for the wave of high-cost drugs now coming to shore.
Achieving a vision of patient-centered healthcare requires multi-stakeholder collaboration each step of the way. As national attention on the use of patient-reported outcomes (PROs) grows, significant progress needs to be made to ensure that they are fairly used for accountability purposes in the context of performance-based payment models.
By the end of 2016, HHS plans to make 30% of fee-for-service payments through alternative payment models, such as accountable care organizations and bundled payments, and tie 85% of all fee-for-service payments to quality or value. This places increasing urgency on healthcare organizations to make a fundamental shift in their approach to care delivery.
In 2014 the healthcare industry saw fundamental change in how health plans approach the market, provider consolidation in many areas, a focus on quality-based payments, unprecedented growth in consumer liability for the cost of chronic illness, and a slowing in the rise in healthcare costs.