The Case for Value Based Medical Care

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Migrating from Volume to … Value







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  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]



5 Responses

  1. Employer Health Care Costs Expected to Increase 4.1% for 2015

    Key findings from the annual Towers Watson/NBGH Best Practices in Health Care Employer Survey include:

    • Employers expect a 4.1% rate of increase in the cost of employer-sponsored health care benefits in 2015.
    • Health care costs for 2015 are expected to average $12,041 per employee, up from $11,567 in 2014.
    • Employer confidence in offering health coverage 10 years from now increased from 25% in 4014 to 44%.
    • On average, employees will pay 22.2% of total premium costs in 2015, or $223 a month on average.
    • 82% of companies offered an account-based health plan (ABHP) in 2015 and 4% will add one in 2016.
    • Half of employers have used new coverage/utilization restrictions to curb high cost specialty pharmacy.

    Source: Towers Watson, October 6, 2015


  2. ACOs working?
    [Experts debate]

    The 20 ACOs in the Pioneer program and the 333 in the shared savings program reported total savings of $411 million.

    But after paying bonuses, the ACOs recorded a net loss of $2.6 million to the Medicare trust fund.



  3. 55% of Executives Expect Most Payments to be Value-Based Before 2020

    Lazard recently released results from their Global Healthcare Leaders Study. Here are some key findings from the report:

    • 47% of executives cite value-based models as transformative in the next decade.
    • 38% cite scientific breakthroughs as most transformative over the next decade.
    • 1 in 3 respondents in devices/tech/services say non-traditional competitors will have a transformative impact on the industry in the next 3-5 years.
    • 55% said they expect most healthcare payments will be value-based before 2020.
    • Half expect an increase in public company acquisitions over the next 18 months.
    • More than two-thirds expect an increase in private company acquisitions.

    Source: Lazard, May 15, 2017


  4. Cyprian,

    Not ever going to happen!

    Dr. David E. Marcinko MBA


  5. Nine Things to Know From GAO Report on Hospital Value Based Purchasing

    1. Safety net hospitals generally scored lower in quality compared to all hospitals
    2. Small rural and small urban hospitals scored higher on efficiency compared to all hospitals
    3. In 4/5 years of GAO’s analysis, small rural and small urban hospitals were more likely to receive a bonus compared to all hospitals
    4. Safety net hospitals were more likely to receive a penalty during this timespan
    5. A majority of all hospitals received a bonus or a penalty of less than 0.5 percent each year
    6. Hospitals receiving a bonus > 0.5 percent increased from 4% of hospitals to 29% from FY 2013 – 2017
    7. Most hospitals had a bonus or penalty of less than $100,000 in fiscal year 2017
    8. Efficiency score had a greater effect on total performance score because of CMS methodology
    9. Hospitals with missing scores were more likely to receive bonuses than hospitals with complete scores.

    GAO Report – June 30, 2017: CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses


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