This week, the Innovation Partners BioBlog looks are breaking articles on how technology can help the shift to new healthcare payment models. Voters agree that the soaring cost of drug prices should be curbed, but disagree on how to do so. CMS delayed its ruling to hospitals and healthcare providers to post their prices, stating they needed time to review, reflect, and respond to comments. These and more are the top stories in this week’s Innovation Partners BioBlog.
Voters say Congress needs to curb drug prices, but are lawmakers listening?
Although nearly 8 in 10 Americans say that the cost of prescription drugs is too high, few agree on how to stop the rising prices. Various proposals are currently in the House and Senate with little bipartisan support for any one particular plan. While all agree that the cost of drugs is too high and that it continues to climb, no one solution appears feasible.
Industry Voices—Medicare patients could lose access to advanced cancer treatment. Congress must intervene
The Center for Medicare and Medicaid Services (CMS) is proposing a new rule that will make it harder for cancer patients to obtain specific treatments. One such treatment is proton therapy. This exact form of radiation therapy is available at top cancer treatment centers, but critics contend that CMS is using outdated studies to judge its success rate. The proposed new rule severely limits access to the treatment.
CMS: Part B premiums, deductibles to rise in 2020
The Centers for Medicare & Medicaid Services (CMS) released information on cost-sharing for traditional Medicare and Part B this week. Increased costs in Part B are associated with rising spending on physician-administered drugs. The standard monthly premium in Part B for 2020 will be $144.60, $9.10 higher than in 2019. Deductibles are set to rise from $185 in 2019 to $198 in 2020, according to the report.
CMS delays rule requiring hospitals to post negotiated prices
The Centers for Medicare and Medicaid Services stated it would delay the proposed rule requiring hospitals to post their standard prices based on their negotiated contracts with insurers. The agency received over 1,400 comments on the proposed rule and intends to summarize and respond to them. They would like time to review the comments and consider a response. Although proponents say that publishing prices will encourage competition, many critics contend that it is too difficult for consumers to understand pricing and that many healthcare-related decisions are made swiftly without time to shop around based on price.
Overcoming barriers to value-based care adoption requires wise use of technology
Value-based care, in which payment is directly tied to clinical outcomes, is slowly making headway in the world of healthcare payments. The traditional fee-for-service model, though, is hard to replace when so many systems and processes are designed around it. This article discussed the many technology challenges facing healthcare providers as they shift to value-based care models, and some possible means to overcome such barriers.
How Payers are Using Episodes of Care to Map the Patient Journey
Patient-centered healthcare requires a shift in approach and technology. This approach to healthcare payment accuracy means that episode-of-care claims data is being used to understand the patient journey throughout the healthcare system better and reveal medical coding discrepancies with unprecedented accuracy and efficiency. This article reviews various payment models, especially bundling conditions and related care into episodes and how technology may assist payers.