In the two-year period of Jan 1, 2015 through December 31, 2017, the Lown Institute found 1.3 million low-value tests and procedures delivered by 3,351 hospitals. The report found that for-profit and southern hospitals had the highest rates of low-value tests and procedures noting that hysterectomies for benign disease were one of the highest tracked…

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Cancer treatment is complicated, and countless sources of information and support are available. With the rise of social media, many cancer patients and their caregivers are using it to seek insight into disease progression, treatment options, psychosocial support, and guidance for navigating care. This third blog post in Discern Health’s Journal of Clinical Pathways social…

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End Stage Renal Disease (ESRD), a state of kidney failure in which dialysis or kidney transplant is required to sustain life, is among the costliest chronic diseases. Historically, individuals with ESRD have been covered by fee-for-service Medicare after a 30-month waiting period. Spending on individuals with ESRD represents 7 percent of CMS spending. Beginning in…

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The Institute of Clinical and Economic Review (ICER) emerged as a critical voice in evaluating value-based price (VBP) benchmarks for drug pricing. However, despite its growing presence in the life sciences industry, the organization’s magnitude of impact on drug pricing is currently unknown. ISPOR conducted a retrospective review of 34 ICER Final reports from November…

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The new Director of the Center for Medicare and Medicaid Innovation (CMMI), Liz Fowler, recently stated that the healthcare system is at a “critical juncture in the path to value-based care.” At the beginning of 2021, CMS placed five payment models under review, delaying or pausing their implementation, and announced that it is no longer…

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Adult vaccination rates in the U.S. lag goals. The COVID pandemic has highlighted this issue in recent months, but there are also gaps in immunization rates for other conditions. Despite the ready availability of vaccines, tens of thousands of U.S. adults die each year from vaccine-preventable diseases. In April, the National Quality Forum released a…

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If the old saying of how to get to Carnegie Hall is “practice, practice, practice,” then how you might get a measure added to a federal health program could be “MUC, MUC, MUC.” The Measures Under Consideration (MUC) is a vetted list based on measurement priorities and is put before stakeholders and the measurement community…

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In the waning hours of the Trump administration, Seema Verma and other top Centers for Medicare & Medicaid Services (CMS) officials penned a blog in Health Affairs outlining key areas where the administration had advanced accountability by moving beyond fee-for-service payment. One particular action of note was a final rule issued Dec 31, 2020 that…

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In April’s Health Affairs, Nerenz et al., note that of lack of consensus around social risk adjustment of quality measures is becoming a concern, given the expansion of CMS’s Quality Payment Program. The inclusion of individual physicians and physician groups and other clinicians in value-based payment has raised awareness about potential biases against safety-net providers,…

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COVID-19 has been the greatest global public health challenge in the last century, and has been hugely impactful domestically, with more than 550,000 reported deaths, representing the third leading cause of death in 2020. The impact of this crisis across the value landscape has been nuanced. In some cases, COVID-19 has accelerated the pace of…

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