What you need to know about the forces reshaping our industry.


February 9, 2017

ACO roundup: Here's how Maryland's global payment model is working out

Daily Briefing

This week, insurers pivot toward value-based care, a look at physician-focused payment models, and more.

  • Insurers pivot toward value-based care. Three of the nation's largest health insurers say nearly half of payments are now value based. For instance, during recent earnings calls Aetna's CEO Mark Bertolini said 45 percent of Aetna's medical spending is now tied to value and Anthem CFO John Gallina said about 43 percent of Anthem's payments are made through shared savings programs. In addition, a UnitedHealth spokesperson said, 45 percent of the company's "total annual medical spend" is now value based. Bertolini said the shift to value-based payments is paying off for patients. "For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission," he said.  

  • Radiologist should embrace physician-focused payment models. Physician-focused payment models (PFPMs) are alternative payment models (APMs) that aim to control costs and improve quality—but focus on new specialties or issues not addressed by existing APMs. According to a report from the Harvey L. Neiman Health Policy Institute, PFPMs may prompt more radiologists to participate in Advanced APMs under the Medicare Access and CHIP Reauthorization Act (MACRA). Andrew Rosenkrantz, lead study author, said PFPMs may also help other specialties "develop and propose new practice models that will allow a more diverse range of physician specialists to participate in [APMs]."

  • Here's how Maryland's global payment model is working out. Maryland's global payment model is paying off, achieving quality improvements on top of hundreds of millions in Medicare savings, according to a Health Affairs Blog post. In 2014, CMS and Maryland reached a five-year deal for all payers to set global annual budgets for hospitals to cover both inpatient and outpatient care. So far, Maryland has achieved an estimated $429 million in total Medicare hospital savings, surpassing the $330 million the state promised CMS it would save over five years.

From Advisory Board:

No-regrets investments to bolster population health. The health care industry is entering the next era of health care reform, which will center on hospital and health system leaders transforming the delivery system to meet two profound and lasting market evolutions: population health and consumerism. At this year's Health Care Advisory Board national meeting, we're helping you identify and prioritize the no-regrets investments that will support success toward both of these goals.

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Advance your care transitions process beyond re-admissions. Join us on Thursday, Feb. 16 for a webconference focused on helping you elevate your care transitions process with proven best practices. From prioritizing transition support based on acuity to using home visits to bridge the hospital-primary care transition, we will get you up to speed on leading strategies to capture cost savings and increase quality during the transition process.

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How achieving systemness can improve pharmacy efficiency, quality, and patient experience. Join Advisory Board Senior Consultant Regina Lohr for a webconference on Monday, Feb. 13, to learn how to integrate pharmacy services across a multi-hospital health system with the goals of improving financial and clinical performance.

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