Value Propositions

VBCR - December 2013, Volume 2, No 6 - Value Propositions

New Hepatitis C Therapy Can Help Some Patients with Rheumatic Disease
The US Food and Drug Administration (FDA) approved oral sofosbuvir (Sovaldi; Gilead) in a once-daily dosing for the treatment of chronic hepatitis C virus (HCV) infection. This is the first treatment for HCV infection that can be used without concomitant interferon injection, which could lead to severe flulike symptoms. This is also the first FDA-approved treatment for HCV infection that can be used by patients whose rheumatic disease prevents them from using interferon. Sofosbuvir is a nucleotide analog inhibitor that was designated by the FDA as a “breakthrough therapy,” which allows for a rapid approval process. The drug can be used in combination with interferon and with ribavirin, depending on the HCV infection genotype. For patients with genotype 2 and 3, it can be used with ribavirin, without interferon. Gilead Sciences, Inc; December 6, 2013


A New Model for Value-Based Physician Reimbursement
Value-based care is becoming central to the attempt to reform the US healthcare delivery system and patient care. The model of physician payment using relative-value units (RVUs) was developed a few decades ago to provide a uniform formula to pay for medical services. With the enhanced focus on value-based care, Eric C. Stecker, MD, and Steven A. Schroeder, MD, have recently suggested that “creating a new RVU-based system that incorporates value considerations has important advantages over pay-for-performance programs, salaries that are not tied to incentives, and physician-level capitation.”

They add that RVU-based physician measures “are proven, potent, and efficient motivators of physician behavior. Simple fixes to promote value could rapidly align physicians’ practice patterns with other elements of a value-focused health care system. Value-based RVUs could thereby serve as a bridge for physicians in the transition away from fee-for-service payments, promote important primary care services, and improve the integration of specialty care into new delivery models. A reformed RVU system could remain central beyond fee for service, since methods such as global and bundled payments do not account for or direct the distribution of physicians’ work efforts within health systems.” N Engl J Med. 2013;369:2176-2179


Physicians’ Role in Payment Reform
American physicians in different specialties are taking the initiative in testing new payment and delivery models. Several of these groups described their efforts at a recent forum on physician payment reform that was held by the Brookings Institution in November 2013. The current fee-for-service model is fraught with problems for physicians, from a payment and a quality-of-care perspective, which is presenting obstacles in creating new payment and care delivery models, said Harold D. Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, during the Brookings Institute forum.

Mr Miller discussed new payment models for physician reimbursement that would offset the new Medicare cuts to physician reimbursement that will take effect in January 2014. If these new models were implemented, he said, “they would more than pay for the offsets of $150 billion over 10 years needed to pay for the SGR [sustainable growth rate].” He added that physicians need support to bring about a new payment system. Healthcare Finance News; November 25, 2013


Efficacy of Hyaluronic Acid Injections Similar to NSAIDs for Knee OA
Results of a new meta-analysis of 5 randomized controlled studies show that intra-articular hyaluronic acid (IAHA) may be an appropriate alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with knee osteoarthritis (OA), especially in patients who are at an increased risk for NSAID-related adverse reactions. The results showed no significant differences between IAHA and ongoing use of oral NSAIDs in relief of pain and stiffness, as well as in improved physical function among patients with knee OA at weeks 4 and 12. The most common adverse event of IAHA was injection-site pain. As can be expected, serious gastrointestinal (GI) events, such as drug-related GI bleeding, were more common with NSAIDs compared with IAHA injection. Overall, the investigators reported that “IAHA is not significantly different from continuous oral NSAIDs at 4 and 12 weeks.” Bannuru RR, et al. Semin Arthritis Rheum. 14 October, 2013; Epub ahead of print


Mayo Clinic Moving from FFS to Value-Based Care
Administrators at the Mayo Clinic are working to “bend the cost curve” and optimize resource utilization efficiency, according to Kari Bunkers, MD, Chief Medical Information Officer, Mayo Clinic Health System, and Medical Director, Mayo Clinic Office of Population Health Management. The goal is to transform their community and regional practices from fee-for-service (FFS) care to value-based care within the next 2 or 3 years. Mayo Clinic providers are now focusing on a data-driven, team-based approach to coordinate care based on each patient’s unique needs.
Mayo Clinic has identified 10 key components related to value-based care, including prevention, community engagement, wellness, team-based care, patient engagement, access optimization, care coordination, smooth care transitions, and effective chronic disease management and palliative care. “We are determined to deliver better-coordinated care for patients, with a better overall experience through engaging them in ways that work for them, and by focusing on health, wellness, and outcomes,” said Dr Bunkers. 2013 AMGA Institute for Quality Leadership Conference; September 25-27, 2013

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Last modified: May 21, 2015
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