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Signs That Payment Reform is Here to Stay

Originally featured on wanthealthcarellc.com.

There was a significant announcement out of HHS on Monday, January 26th, about payment reform. Here is an excerpt from an industry article:

“The new goal is that by the end of 2016, 30 percent of fee-for-service Medicare payments will become value-based payments through alternative payment models like Accountable Care Organizations (ACOs) or bundled payment arrangements. This will increase to 50 percent of payments by the end of 2018.

HHS has also set a goal of 85 percent of all traditional Medicare payments shifting to quality-based by 2016 and 90 percent by 2018. This will happen through programs like Hospital Value Based Purchasing and the Hospital Readmissions Reduction programs.”
 

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SIM. What's All the Excitement About?

On December 16, 2014, the staff at CIVHC spontaneously started yelling and dancing. No, we were not celebrating the upcoming holidays with synchronized glee, nor were we working on “Colorado APCD: The Musical”. We were throwing a party because the long awaited Centers for Medicare and Medicaid Innovation State Innovation Model Round 2 funding awards were released and two long years of work were being rewarded. Colorado was awarded $65 million dollars to implement the Colorado state innovation model and was one of only 11 states awarded dollars to fund implementation of a statewide plan. While we here at CIVHC have been living and breathing SIM for the past two years, it might not be as familiar to all of you. Let me give you a brief history of the work that has been put into SIM and hopefully you’ll see why we’re so excited.

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Readmission Penalties Give Hospitals a Reason to Spend Money on the Right Things

There was a story in the Denver Post this week about Medicare’s penalty for readmissions being charged to 27 Colorado hospitals that participate with Medicare. On average, these hospitals were penalized 1/3 of one percent of their total Medicare reimbursement. In the case of one large hospital system, this amounted to about $300,000 out of a total revenue stream of $2.7 billion, or about 1/100 of one percent. At this level, one might wonder if it’s worth the trouble to administer, or if anyone is really paying attention.

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Big Data: Key Ingredients for Informing Innovation

The term “Big Data” is a popular phrase these days across social media and blogs, especially when it comes to health care. It’s not surprising given the challenges we’re facing with health care at the national level and the fact that data is key to managing any improvement effort. While the term “Big Data” is becoming synonymous with the golden ticket, it has the potential to become dangerous when used too broadly without a common definition. When it comes to data - “big” or “small” - not all are created equal, but the power of the right data can be instrumental to identify and inform meaningful, innovative change.

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My Prescription is How Much?

When we think of filling our prescriptions with generic drugs, we generally consider them a low cost, equally effective alternative to a brand name medication. We’ve also heard about the power of generics to move the price of brand name drugs and lower prescription medication spending overall. A recent example of this is Lipitor. Lipitor (generic name Atorvastatin) is a widely used cholesterol lowering medication that became available in the last half of 2012 as a generic. The generic version provided a lower cost option at less than one third of the cost of the name brand Lipitor. CIVHC analysis of data from the Colorado All Payer Claims Database pre and post-introduction of the generic version of Lipitor shows that the price per day for the brand Lipitor also dropped substantially as a result of generic competition which provided consumers with more alternatives.

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