News
National Quality Forum Calls for Better Health Outcomes
August 2021
During the 2021 National Quality Forum Annual Conference, titled “The Care We Need: Driving Better Health Outcomes for People and Communities,” presenters from around the country addressed topics of health equity, structural racism, and the perpetuation of disparities and mistrust. The presenters represented diverse individual perspectives and professional and personal experiences that provided meaningful context…
Utilization Management Efforts Have Their Own Costs
August 2021
Drug utilization management has long been a tool used by health plans, pharmacy benefit managers, and states to effectively manage their pharmacy costs. Those management efforts have costs of their own and a recently published review seeks to quantify those burdens to patients, providers, manufacturers, and payers. The review reports that these stakeholders have combined…
Value in Health Care Act Reintroduced to Kickstart Medicare ACOs
August 2021
The Value in Health Care Act introduced in Congress has received the support of fourteen major groups in health care ranging from the American Medical Association to America’s Health Insurance Plans to the major hospital organizations in the country. The aim of the legislation is to attract more participation in the Accountable Care Organizations (ACOs)…
COVID-19: Where Are All the Health Economists?
August 2021
The COVID-19 pandemic has wreaked havoc on all parts of the economy. Yet, there has not been much uptake of health economics. Reasons suggestive of such lack of engagement include the absence of standardized protocols for evaluating vaccination. In addition, cost estimates are extremely complex and difficult especially because there is no transparency about the…
New Proposed Rule for Physician Fee Schedule
August 2021
Last month, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule for Calendar Year 2022 Proposed Rule, or CY 2022 PFS Proposed Rule. This proposed rule continues a number of trends across the healthcare landscape, with public comments due by September 13. Key areas of the proposed rule include: Telehealth:…
Discern Health Shapes Medicare Payment Policy
July 2021
On July 13, Medicare released planned updates to its physician payment regulations. The proposed rule includes changes to value-based payment programs, including several proposed by Discern Health in partnership with its clients. One update relates to COVID. Last year, Discern’s staff discussed ways the organization could use its expertise in Medicare payment to respond to…
CMS Report Shows that Quality Measures Matter
July 2021
CMS recently published their 2021 National Impact Assessment Report of Quality Measures. The triennial report, which scans the 26 different CMS programs, found progress in key priority areas. 91% of CMS’s analyzed measures demonstrated stable or increased performance, which shows that measuring quality improvement matters. For example, the “Patients over Paperwork” and “Meaningful Measures” efforts…
Driving High-Value Care through Value-Based Hospital CEO Incentives
July 2021
A recent Health Affairs blog suggests that value data could be used to improve CEO incentive compensation systems to drive high-quality, affordable health care. Using risk-adjusted data from the CMS value-based purchasing (VBP) program, the authors looked at a cohort of 21 major west coast and southwest teaching hospitals. Analysis revealed that there was no…
The Threat of Competition: Incumbent Drug Manufactures Raise Prices in Anticipation of Market Competition
July 2021
Traditional economic theory predicts that competition will counteract growth in drug prices. Surprisingly, success of competitor’s clinical trials and new drug application (NDA) submissions seem to represent exogeneous “pipeline shocks” that cause incumbent drug manufacturers to raise prices before rival candidates appear on the market. From 2007 to 2015, pharmaceutical companies raised the price of…
Pfizer Challenges Medicare Anti-Kickback Statute Preventing Copay Relief to Patients
July 2021
Out-of-pocket expenses for patients are a hot topic and the rules of the road for whose out-of-pocket costs can be covered is the subject of a current lawsuit in federal courts. Pfizer filed the lawsuit challenging federal anti-kickback laws in Medicare to allow manufacturers to pay or provide some offset to a patient’s copays. Currently…