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Insights You Don't Want To Miss

By: Lisa Remington, President Remington Health Strategy Group, and Publisher, The Remington Report

Payors and providers are redefining and rethinking how new models of care can move the needle toward value-based care. Learn about recent examples.

The government should find ways to encourage Medicare beneficiaries to use higher-quality post-acute care providers following a hospital stay. That was the gist of a presentation at the Medicare Payment Advisory Commission’s (MedPAC) September session in Washington by Senior Analyst Evan Christman.

A home-based palliative care (HBPC) program tested within an accountable care organization (ACO) demonstrated substantial cost savings and reduced hospital admissions for patients near the end of life, according to a Journal of Palliative Medicine study.

An Advanced Copy of Interpretive Guidelines was recently released by CMS: a new Appendix Z of the State Operations Manual (SOM), which contains the interpretive guidelines and survey procedures for the Emergency Preparedness Final Rule.

It is estimated that total health and long-term care costs for persons with Alzheimer’s and other dementias in the United States will total $259 billion in 2017, more than two-thirds of which is expected to be covered by public sources such as Medicare and Medicaid.

Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. They are among the most costly patients in the U.S. health care system, not because of a specific disease but because of a powerful combination of multiple chronic conditions, functional impairment, frailty, and social stressors.

  • The full scope of their needs is not met by any of the existing formal health services – ambulatory, hospital, emergency department (ED), hospice, or skilled home health care.
  • Their needs and their limited ability to access primary care commonly result in unnecessary ED visits, hospitalizations, and downstream health care expenditures.
  • These patients account for approximately half of the costliest 5 percent of patients.

The Comprehensive Care for Joint Replacement payment model CMS announced proposes to hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service beneficiaries for hip and knee replacements from surgery through recovery. The hip and knee bundle program would include quality measures for complications, readmissions and patient experience.

Is the next wave of health outcomes moving to tie C-Level compensation to their pay?

A recent filing by Humana with the Securities and Exchange Commission indicates the insurer is instituting a new compensation model in which bonuses are not just tied to company financial performance, but also to enrollee’s health outcomes.

The FirstHealth Care Management Model

FirstHealth of the Carolinas, a comprehensive rural health care system based in Pinehurst, North Carolina, has developed an innovative care delivery model to ef­fectively manage high-risk patients with chronic disease. This model, referred to as the FirstHealth Care Man­age­ment Mod­el, was developed and is delivered by the organization’s home health care entity and includes three ma­jor components:

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