Unbiased Analysis of Today's Healthcare Issues

Archive for the 'P4P' Category

Aligning Incentives

An interesting story at AJMC on a new type of wellness program that better aligns outcomes with reimbursement: “Most wellness programs are like most gym memberships,” Adam Fawer, Noom’s chief operating officer, said in an interview. Employers have spent lots of money on programs that fail to help or even reach most of the staff, […]

Read the rest of this entry »

Bengt Holmström’s Nobel Prize Lecture

Nobel Prize winner Bengt Holmström talks about the pros and cons of  pay-for-performance.  Interesting throughout.

Read the rest of this entry »

VBID in TRICARE

Value-based insurance design looks to be expanding. As the American Journal of Managed Care reports: The bill calls for a pilot demonstrating the feasibility of incorporating VBID by “reducing co-payments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers” no later […]

Read the rest of this entry »

Can we accurately classify physicians as high vs. low quality?

Medicare aims to tie 90% of reimbursement to quality measures.  The potential for quality-linked reimbursement to incentivized improved quality of care, however, depends critically on whether physician quality can be measured reliably. Profiling individual physicians is difficult. Sample sizes are small and attributing patients to a single physician can be difficult (as Mehtrotra et al. 2010 […]

Read the rest of this entry »

The AMA on value-based drug pricing

The American Medical Association released a statement yesterday in support of value-based pricing of pharmaceuticals.  However, AMA claims that value-based pricing should follow the following core principles. Value-based prices of pharmaceuticals should be determined by objective, independent entities. They also should be evidence-based and the result of valid and reliable inputs and data that incorporate […]

Read the rest of this entry »

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: […]

Read the rest of this entry »

How are payers tackling value-based drug pricing?

A growing number of value-based drug pricing arrangements are tying the price of treatments to outcomes. While these payment models are far from prominent now, is it likely that drug makers will have a greater share of the risks and rewards associated with value-based care moving forward? This is what is written in a feature […]

Read the rest of this entry »

Another VBP fail?

Value-based purchasing is supposed to tie reimbursement to quality of care and costs.  Providers that are high quality and low cost are supposed to get higher reimbursement, those that are low quality and high cost the reverse.  The key question is: does this reimbursement approach work in practice? According to a recent study by Grabowski […]

Read the rest of this entry »

VBID comes to Medicare Advantage

CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients.  I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees […]

Read the rest of this entry »

Will value-based pricing be coming to the U.S.?

The answer may be yes.  One of the big inpediments to value-based pricing of pharmaceuticals was that any discount given to any single organization based on outcomes needed to be reflected in the Medicaid price.  Since outcomes are subject to random noise, there will inevitably be health plans that end up getting a low price due to worse than expected […]

Read the rest of this entry »