Payer perceptions of value frameworks

A paper by Westrich et al. (2023) examines payer perceptions of five different value frameworks. Value frameworks of interest included: American Society of Clinical Oncology (ASCO) Value Framework, Drug Pricing Lab’s Drug Abacus (formerly Memorial Sloan Kettering Cancer Center’s Drug Abacus), Institute for Clinical and Economic Review (ICER) value assessment framework and evidence reports The…

Alternative Payment Models: Where are we now?

Health Care Payment Learning and Action Network (HCP LAN) is dedicated to moving the health care system from volume-based, fee-for-service reimbursement, to alternative payment models (APM). While there are a large number of different types of APMs, broadly, all of them shift more financial risk to providers while also linking reimbursement to quality of care.…

Does episode-based payment reduce cost?

That is the question that Carroll and co-authors try to answer in their latest NBER working paper (WP #23926).  They examine the Arkansas Health Care Payment Improvement Initiative (APII), which is a state-wide, multi-payer episode-based program.  Unlike most episode-based payment (EBP) models, provider participation  in the program was mandatory (as of 2013).  NBER summarizes the program…

Is VBID gaining a foothold?

The answer is maybe.  Value-based insurance design ties patient cost sharing to the notion of a treatment’s value.  Higher value treatments have lower cost sharing; lower value treatments have higher cost sharing.  The Incidental Economist writes: In his own practice, Dr. Fendrick feels as if standard insurance is working against him and his patients. “They are deeply…

Smarter deductibles?

Are high deductible health plans a good thing?  Republicans typically argue yes as they say that increased cost sharing reduces moral hazard.  That is, when people have to pay for medical care out of pocket, they don’t ask for unnecessary care or use care more frugally.  Democrats typically argue that increased cost sharing reduces demand…

Are quality bonus payments based on hospital readmissions reliable?

Maybe not.  That is the answer from a study by Thompson et al. (2016).  Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for six states (AR, FL, IA, MA, NY,WA)  from 2011 to 2013, the authors measure hospital performance reliability for the Hospital Readmission Reduction Program (HRRP).  The define reliability as follows:…