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Practice Transformation

Where care is delivered heavily influences both the price and the price variations. The potential for savings is tremendous, but that potential hasn’t been fulfilled. One reason is the challenge of getting physicians to alter their referral practices. The Clinician Behavior Change Model addresses that challenge. A recent Harvard Business Review article looks at the model in the context of selecting lab testing sites. Among the lessons: “By identifying clinicians who are more and less amenable to changing their referrals to certain sites of service, the model allows payers to focus efforts on those most likely to change, which may produce a higher return on investment in the behavior change program.” (Harvard Business Review)
Including community health workers on the care team—especially during the pandemic—may provide relief for burned-out physicians, John Resendes, MA, of the NC Department of Health and Human Services told attendees at a recent virtual conference. COVID-19 has spurred “a lot of bidirectional communication and process flows from the health care and support services sectors,” he explained. “As these referrals come through, community health workers act as the middle hub of the spokes on the wheel, connecting and navigating for these individuals so that they can have the resources to help quarantine and isolate.” (Healio)

Evidence & Innovation

Three factors determine the burden of health care costs for those with job-based insurance: median income, premium contributions and deductibles. If those premiums and deductibles don’t fall this year, income lost during the current economic crisis will increase cost burdens for middle-income families, according to the Commonwealth Fund. Premium contributions and deductibles in employer plans accounted for 11.5% of median household income in 2019, up from 9.1% a decade earlier. People living in states with lower median incomes face higher absolute costs compared to people in states with higher median incomes. (Commonwealth Fund issue brief)
Pfizer’s coronavirus vaccine could be approved and roll out across the U.S. at the end of the second week in December, according to Moncef Slaoui, the chief science adviser for Operation Warp Speed. The first people could receive the vaccine on Dec. 11 or Dec. 12, with a goal to immunize 20 million people by the end of December. Another 30 million could be vaccinated each month after that. (Medscape)

Policy Solutions

CMS has finalized modifications to the Stark Law; changes go into effect Jan. 19, 2021. Stark has been modified often since 1989, but these are the most extensive changes. Among other things, the final rule provides exceptions for certain value-based compensation arrangements between or among physicians, other providers and suppliers. “The final rule unleashes innovation by permitting physicians and other healthcare providers to design and enter into value-based arrangements without fear that legitimate activities to coordinate and improve the quality of care for patients and lower costs would violate the Stark Law,” according to CMS. (Becker’s Hospital Reviewfinal rule)
President Trump recently announced two major actions aimed at lowering prescription drug prices. An interim rule would lower drug prices in Medicare Part B to match the lower prices paid in other wealthy countries, a proposal known as “most favored nation.” The second, a final rule, eliminates the rebates that drugmakers pay to pharmacy benefit managers; it would pass the discounts on to consumers instead. Industry groups are likely to launch legal challenges to the moves. The Hill notes that the most favored nation rule is similar to many Democratic proposals and is opposed by many congressional Republicans. (The Hill)
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In Case You Missed It!

In November, 475 GTMRx signing members registered to attend our four-part Member Feedback series. These events showcased the tools developed from 140+ GTMRx experts on the following topics: how we pay, practice, use diagnostics and integrate technology. These tools are soon-to-be released guidance documents your organization can use to advocate for reform. Learn more about the events and watch the recordings here.
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