Practice Transformation
CMS’ vision: coordinated, team-based and equitable care
The future of value-based care includes reducing the number of payment models and increasing health equity, according to CMS. It plans to prioritize coordinated, team-based care, outcomes measurements that matter to patients, and holding providers more accountable, CMS and CMS Innovation Center leaders wrote in a recent Health Affairs Blog post. Their objective: a health system that eliminates disparities through high-quality, affordable and person-centered care. The agency plans to put health care equity at the center of each model going forward. (Modern Healthcare*; Health Affairs Blog)
Evidence & Innovation
Shortage of good drugs, increased use of bad drugs
Tocilizumab, an anti-inflammatory drug used to treat severe COVID-19, is in short supply; the FDA added tocilizumab to the drug shortages list last week, The Wall Street Journal reports. Meanwhile, the FDA reports growing interest in ivermectin—a medication used for horse deworming—as a COVID treatment. The agency has received multiple reports of patients who have been hospitalized after self-medicating with the it. Meanwhile, ABC News reports that Mississippi officials are seeing more calls to poison control for people taking the veterinary medication. (Wall Street Journal; FDA; ABC News)
Google closes its health umbrella
Google is dissolving Google Health. The unit’s chief, David Feinberg recently announced he was moving on to become CEO of Cerner. The company is splitting its health projects and teams across several other divisions, Healthcare Dive reports. It will continue to invest in the space, and the goal of the reshuffling is to put its teams in the areas that make the most sense for its projects, the company says. “Moving teams closer to the work of some of our core areas will be good for execution,” Chief Health Officer Karen DeSalvo tweeted recently. (Healthcare Dive)
Spending analysis reveals stark disparities
White Americans received 72% of all healthcare spending in 2016 despite making up 61% of the population, according to analysis published in JAMA that found major disparities in racial and ethnic health spending. “Latinos in particular often lack access to high-quality health care and are among the least likely of any racial or ethnic group to visit the doctor when they have a medical issue,” said Amelie G. Ramirez, DrPh, of UT Health San Antonio. “As a result, they suffer from poorer health outcomes on a range of measures. This study highlights the urgent need for new investments in Latino health.” (Patient Engagement HIT; JAMA; announcement)
Policy Solutions
Considering the impact of vaccine approval
Officials are optimistic that last week’s approval of the Pfizer/BioNTech vaccine will change the minds of the vaccine hesitant. It’s also led to more vaccine mandates. The Advisory board Daily Briefing offers some guidance to employers, provider executives and front-line clinicians. Finally, although full approval gives physicians the legal grounds for off-label use, pediatric infectious disease experts warn that it should not be used off-label in children under 12. (Kaiser Health News; MedPage Today*; Advisory Board Daily Briefing)
Political fortitude required for value-based care
Even if CMS improves payment policies and information sharing, it may not make much difference as long as providers can easily make money through fee-for-service reimbursement. Experts tell Modern Healthcare that Congress must make FFS less attractive if value-based care is to succeed. “Lawmakers are punting here because it takes political fortitude to squeeze fee-for-service. CMS has demonstrated that it’s willing to go there, but it gets no political protection,” says Mai Pham, MD, MPH, a former CMS chief innovation officer. “Don’t blame value-based care for not being effective when you keep giving people a sugar high on fee-for-service.” (Modern Healthcare*)
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In Case You Missed It!
GTMRx Payment and Policy Solutions Workgroup leadership met with AAFP’s FPM “How to Integrate Clinical Pharmacists Into Primary Care” authors Shaowei Wan, PharmD and Peter Teichman, MD to discuss barriers and opportunities for reimbursement of CMM level services in team-based care.
The GTMRx Institute released a 5-minute survey, open until Aug. 25, seeking insight into successful payment models in place for CMM services. If you’re organization is providing CMM services, your input is welcomed. (survey)
The Association for Accessible Medicines, a company working to ensure more generic and biosimilar medicines are more accessible to more people who need them, has dedicated to repairing the United States’ $528 Billion and 275,000 deaths a year suboptimal medication management problem by joining the GTMRx Institute as a bronze Strategic Partner.
We are sharing new survey results that assess the medication management habits and needs of over 1,000 people. Nearly one quarter of people cited that their medications are not routinely reviewed and evaluated by their medical team—shocking, given that one-third are taking four or more medications and/or supplements per day. The GTMRx Institute staff, workgroup and taskforce leaders and participants have created a set of tools to help inform and educate the consumers of health care services—and providers who have direct contact with the consumers—about why it’s important to get the medications right. We invite you to read more, share these tools and join us to ensure appropriate use of medications.
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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