Value-Based Care Research Round-Up


Brian Bastean, PharmD, MBA, Founder and Principal, Value-Based Outcomes Evidence (New Hope, PA), and editor of the journal, has identified some of the most important and influential research in recent months contributing to value-based care, health economics and outcomes research, and clinical pathways. Read a brief synopsis of these key articles below.

Diabetes Centers of Excellence

In an article titled “Clinical Diabetes Center of Excellence – A Model for Future Adult Diabetes Care” (The Journal of Clinical Endocrinology & Metabolism; online January 4, 2018), researcher propose a framework to guide the advancement of a clinical diabetes center of excellence. Boris Draznin, MD, PhD, University of Colorado, and colleagues identify the shift toward value-based purchasing and reimbursement as a driving force behind the need for broader implementation of diabetes centers of excellence as a way of improving the population health, patient care experience, and reducing health care costs. Researchers envision a clinical diabetes center of excellence composed of six pillars serving as guiding principles for developing expertise and readily available for stakeholders.


Patient Involvement in Bundled Payment Incentives

An article titled “Bringing patient incentives into the bundled payments model: Making reimbursement more patient-centric financially” published in the international Journal of Healthcare Management (online January 19, 2018) makes the argument in favor of including patients in bundled payment financial incentives. James J Gillespie, PhD, JD, MPA, Center for Healthcare innovation (Chicago, IL) and a colleague attest that the bundled payment model is an exemplar of reimbursement innovation. After delving into key elements of incorporating payoffs for patients and discussing future challenges and opportunities for embedding patient financial incentives within the bundled payment models, the point is made that incorporating patients into the financial fold has the potential to solidify episode-based payments as an element of the alternative payment models promoted by CMS and private payers.


Clinical Pathway Vendor Conflicts of Interest

Clinicians and payers have continued to make the switch to oncology clinical pathways as a means of delivering high-value care. In a research letter published in JAMA Oncology (online December 21, 2017), Bobby Daly, MD, MBA, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues identify and quantify financial conflicts of interest among oncology clinical pathway vendors. “Financial Conflicts of Interest Among Oncology Clinical Pathway Vendors” highlights the concerns and complexities around oncology clinical pathway development transparency, including the potential for participants to be subjected to lobbying by numerous entities. Researchers conclude that to ensure patient and clinician trust and maintain momentum in the value space, pathway developers need to be transparent about financial conflicts of interest and how those interests are managed.


Bundled Payments System for Breast Cancer

Andrew Pecora, MD, FACP, CPE, and Stuart Goldberg, MD, both physicians at Hackensack Meridian Health (NJ), have designed a disease classification system for use in bundled payments around breast cancer treatment. Hackensack—in collaboration with data analytics company Cota—located 450 patient types from a 3-year review of breast cancer patients. Physicians were able to track the various treatment methods used for each patient, from which Drs Pecora and Goldberg created “lanes of care” that considered best outcomes as well as cost-effectiveness. Already heralded as one of the bigger projects, the patented disease classification system for bundled payments in breast cancer treatment has been given to the Department of Health and Human Services to be reviewed for potential use nationwide.


McKesson Approved By CMS as Participant in MIPS 2018

McKesson Specialty Health has received approval from CMS to participate in the MIPS 2018 program year as a Qualified Clinical Data Registry (QCDR). For the second consecutive year, McKesson will be permitted to collect and report clinical data on behalf of clinicians through its oncology-specific electronic health record—iKnowMed—for both MIPS and custom non-MIPS quality measures to drive improvements in quality and cost of cancer care. McKesson’s QDCR will be able to support all three critical MIPS practice-reported categories (Quality, Advanced Care Information, and Improvement Activities). As a result, iKnowMed user will gain benefits to help them optimize MIPS performance, including a comprehensive end-to-end solution for capture through standard workflow, performance monitoring, and direct data submission to CMS; support for 16 MIPS quality measures; and access to oncology-specific custom quality measures, among other benefits.