As we near the Thanksgiving holiday, we wanted to take a moment to pause, reflect and show gratitude to our partners, colleagues and families as we begin to wrap up what has been a year unlike no other. And while it’s not as delicious as turkey and gravy, our reading list this month includes some food for thought on possible approaches to lowering spending, leaning on innovation, utilizing alternative payment models and considering price control policies from abroad. Bon appétit!

Digging Deeper

Establishing A Value-Based “New Normal” For Telehealth

COVID-19 has spurred the utilization of telehealth across the country. While the platform has reduced costs and enabled better access to care during the pandemic, it’s important to understand the benefits and feasibility of telehealth for patients beyond these trying times. And, it is crucial to understand the care and cost implications before it is widely adopted moving forward.

In a Health Affairs blog post, researchers from the University of Michigan explored the questions and challenges that policymakers should consider before telemedicine is widely adopted, including outlining value benchmarks and taking into account proper reimbursement, regulatory and benefit design issues.

The authors first outlined the “value agenda” for telehealth by acknowledging the complex infrastructure necessary to support telemedicine, such as wireless broadband. Specifically, more needs to be understood to address the “digital divide” in access for underserved, vulnerable and elderly patients. Additionally, researchers must measure clinical, patient-centered outcomes to build a strong understanding of the value virtual care contributes in terms of dollars spent. The authors also urged the Centers for Medicare & Medicaid Services to preserve the previous risk-bearing payment arrangements and value-based insurance design that offered payers and providers flexibility to administer telehealth beyond the typical physician fee schedule.

Why It Matters:  The widespread uptake of telehealth during COVID-19 indicates patients see value in this delivery model. For telehealth to maximize value, reduce costs and enable access, decision-makers must address the policy and regulatory challenges to make this service sustainable for our health care system. We have seen great promise in utilizing video sessions with providers, particularly for patients with chronic conditions who need to maintain regular visits. But this should not be the end of our research. COVID-19 has provided us the opportunity to explore whether and how telehealth can transform our health system. Our mission? Implement it with the most value possible.

What We’re Reading

This month we rounded up various approaches to lowering spending, including leaning on innovation, utilizing alternative payment models and considering other countries’ policies with price controls.

  • Fernandes de Carvalho LS, et al. Machine Learning Improves the Identification of Individuals With Higher Morbidity and Avoidable Health Costs After Acute Coronary Syndromes. Oct. 12, 2020, Value in Health.
    Can a machine learning model predict a patient’s cardiovascular risk for acute coronary syndrome (ACS) and forecast which patients might need long-term care? Yes, according to a study in Value in Health that assessed long-term risk from ACS and identified individuals with a large burden of avoidable costs. This study suggests that machine learning may be another tool to address the ever-persistent issue of low-value care.
  • Silcox C, Bhuiyan Khan B, Ray R, Higgins A, Hamilton Lopez M, McClellan M. Paying for Value: Improving Outcomes, Costs, and Access Through a Condition-based Bundle Payment Model. Oct. 13, 2020, Duke Margolis Center for Health Policy.
    Research from the Duke Margolis Foundation explored bundle payments for aortic stenosis (AS). The current intervention to address the disease is either open-heart surgery, or a minimally invasive procedure. Each treatment option has risks and benefits, but traditional procedure-based reimbursements can deter providers from offering both options. In this paper, the researchers propose a new model to reduce and eliminate misaligned incentives to ensure treatment decisions are based on optimal patient outcomes.
  • Gusmano MK, Laugesen M, Rodwin VG, Brown LD. Getting the Price Right: How Some Countries Control Spending in a Fee-For-Service System. Nov. 2020, Health Affairs.
    The authors examined France, Germany and Japan’s health systems, all of which use centralized price negotiation and price setting for physician reimbursement. Although all three health care systems operate in a fee-for-service setting, they use various methods to limit the volume of services. While centralized price controls in these nations do control reimbursement and ultimately cost, they are not without consequences, including the potential loss of innovation, overly restrictive volume caps and other misaligned incentives. Nevertheless, this study brings to light the challenges and opportunities inherent to adopting these popular types of pricing principles.

Dialogues on Health Spending

  • Texas Communities Town Hall, Continued: Health care stakeholders in the Austin and Houston, Tx., areas met on Nov. 12 for a second Town Hall meeting to determine how to move from dialogue into action in their communities. They pointed out the need to educate their communities about how health care works, ways to reduce low-value care and overcome barriers to accessing health care. Next steps will include identifying a targeted approach and resources needed to develop local programs. The meeting was hosted by the Healthcare Leadership Council, a partner in the GBTS Forum, and NPC.
  • Evaluation Of Medicare Alternative Payment Models: What The Data Show: In Health Affairs, GBTS Forum partner National Association of ACOs explores the results of the past eight years of ACO and Center for Medicare and Medicaid Innovation models and the real-time experiences of health care delivery amid the pandemic.