The U.S. specialty pharmacy industry is growing. Much of that growth can be attributed to healthcare provider-owned pharmacies. This infographic provides a snapshot of some key statistics on the specialty pharmacy industry trend in hospital systems.
Accountable care may still be a relatively new model in some areas, but the numbers of ACOs are steadily increasing. There were approximately 660 ACOs in the U.S. in 2015. The number increased to 838 last year. Success, however, can be elusive.
Patient experience plays a big and increasing role in measures of quality, accounting for eight of CMS’s 34 quality care measures for ACOs, for instance. That’s why many providers and health plans are taking steps to make sure their call centers enhance patients’ satisfaction rather than leave them hanging up in frustration.
“It’s just like with any customer service line, if we have to wait on hold forever, it leaves a bad taste in your mouth,” said Bonnie Zickgraf, integrated services manager for URAC. “Plus, with social media, the bad experiences are 10 times more magnified than the positive ones.”
Hardly a month goes by that we don’t hear about a cyber or ransomware attack on a healthcare provider, manufacturer or health plan. Though major attacks are the ones that make the news, healthcare providers across the country face the risk of an attack of any size.
The Privacy Rights Clearinghouse estimates that more than 900 million records have been breached in the United States since 2005 as a result of nearly 5,200 reported incidents. Of those, about 30 percent—more than 1,500 data breaches—occurred in the healthcare industry.
They say that “states are the laboratories of democracy.” In no place is this more evident than the state of Vermont’s efforts to radically change their healthcare delivery system.On October 26, CMS and Vermont’s Green Mountain Care Board (GMCB) jointly announced the Vermont All-Payer Accountable Care Organization (ACO) Model. This new, first of its kind initiative is aimed at accelerating healthcare delivery reform for the entire state and its population by establishing a statewide ACO that is responsible for the health outcomes of its entire population.
If physicians don’t understand MACRA – or think they don’t need to understand MACRA – how will ACOs get physician practices to align with the requirements of the Patient-Centered Medical Home (PCMH) model?The transition from traditional fee-for-service to value-based payment models, and the focus on patient-centered medical care and population health, has driven the proliferation of Accountable Care Organizations (ACOs).
With the final MACRA rule released on Oct. 14, the industry is now getting the chance to dig into all of the details of this 2,300-page document, especially the act’s Quality Payment Program, which replaces the Sustainable Growth Rate formula with two tracks of reimbursement—the Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS).
“Folks are now in the process of getting their heads around what’s in the final rule and determining what they have to do to respond in 2017,” said Aaron Turner-Phifer, URAC’s director of government relations and policy. “The most important thing right now is for practices and clinicians to be engaging with their medical societies and educating themselves on the best path forward.”
Watch this video for quick overview about MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and what you need to do to succeed in the new healthcare economy.