Value-based care week 3: Telehealth, consumer accountability

Bambi Francisco Roizen · August 29, 2017 · Short URL:

Employers to offer more telehealth services; ACO challenges; Blue print for VB care

Here's our latest value-based weekly! Sorry, the team has been busy the last couple weeks, so I'm stepping in, temporarily.

Editor's note: Join us for a highly-curated gathering to discuss value-based care challenges, opportunities and innovations. Check out our SplashX Invent Health small gathering, co-hosted by HP.)  

In the most recent news, it appears more than a third of employers are incorporating some type of value-based care program into their health plans in 2018, which encourages employees to do their part and stay healthy. That's according to the National Business Group on Health (NBGC) .

This comes as employers are dealing with higher costs - again. The survey, titled "The Large Employers’ 2018 Health Care Strategy and Plan Design" found "employers project the total cost of providing medical and pharmacy benefits to rise 5% for the fifth consecutive year in 2018."

The report says that employers want to reduce the amount employees pay (such as in co-pay or premiums) as long as they "take steps to manage chronic conditions or obtain higher-quality or more efficient care." Also in the report, some 96 percent will make telehealth services available in states where it's allowed next year. 

Read more.

Cutting red tape

Lawmakers can encourage the move to value-based care by cutting red tape, the AMGA said in a letter to Rep Pat Tiberi, the Chairman of the House Ways and Means Subcommittee on Health. The AMGA is a trade organization representing 450 multispecialty medical groups and integrated systems of care.


The group made several recommendations, including: 

The Centers for Medicare & Medicaid Services (CMS) should reduce the number of quality measures. It should also move to a more outcome-based system based on claims data. Eliminate appropriate use criteria. Reduce documentation requirements for chronic care. Suspend meaningful use regulations. Amend physician self-referral laws. Expand telehealth -- basically CMS should waive the geographic limitations for telehealth use for all providers participating in value-based models. Waive the three-day qualifying inpatient stay for skilled nursing facility

What's the three-day qualifying inpatient stay?

For many Medicare patients who have chronic conditions that send them to the hospital or emergency room more often than they like, sometimes they end up going to a nursing home straight from the hospital. But if they weren't admitted to the hospital for three days, Medicare doesn't pay for the nursing home costs. 


Apparently, this lack of coverage is unbeknownst to many patients because some patients stay in the hospital under "observation" care. This care inside the hospital is for patients who are still too ill to be sent home, but not sick enough to be considered admitted. 

Earlier this year, the Notice of Observation Treatment and Implication for Care Eligibility Act went into effect. This law required hospitals to make patients aware if they're under observation care or not. 

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Challenges around Accountable Care Organizations  

Accountable Care Organizations are organizations that tie quality metrics with the cost of care. The ACO model actually builds on groups and practices established by the 2003 Medicare Prescription Drug, Improvement and Modernization Act.


Today, there are 923 ACOs vs 61 in 2010, according to Health Affairs.

In the past year alone, the number of ACOs operating rose 11 percent and the volume of ACO contracts in place grew by about 13.8 percent. As a result, more than 10 percent of the population belonged under an ACO contract by the start of 2017.

But there are challenges they face, such as cultural change and contract management, according to RevCycle Intelligence.

Read more.

Constructing the architecture  

Oooh - a blue print. Those are handy. Thanks to Chad Johnson, Senior Vice President, of Phoenix Children’s Care Network (PCCN) and former CEO of the Children’s Health Network in Minneapolis, who wrote up his experience at PCCN. 

"From a value-based perspective, constructing the architecture of PCCN incorporates several key initiatives, which may provide a blueprint for other health systems developing clinically integrated organizations." Here are some initiatives: A centralized care-­management model for defined populations across all aspects of the care continuum. A data analysis and reporting platform that aggregates data from payers, EMRs, claim files, labs, pharmacy and other relevant data sources. Toolsets for providers to administer "proactive management" vs "reactive medicine." Move away from fee-for-service payer contracts and move to a full-risk paradigm.

Read more.

Interesting reads...

What is the aim of an accountable care organization?

Get your value-based care house in order by embracing primary care.

Image sources: Grocery headquarters; Seniorlivingbrokerage, hitconsultant

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Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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