CER Daily Newsfeed

More on the Tax-Cuts-and-Medicaid-Cuts Bill

(7/8, Brian Reid, Cost Curve) comments “...At the top of my list is this new Health Affairs piece from a group led by Tufts researchers. Tufts maintains a huge database of payer coverage policies, which makes it easy to compare how payers think about utilization management as compared to, say, how medical professionals recommend that medicines be used. The Health Affairs article, which was funded by NPC, found that payer step therapy policies generally didn't align with professional guidelines, ‘rais[ing] concerns about whether the restrictions are excessive and unnecessarily delay patients' access to care.’” Subscription Required

Personalizing Race and Ethnicity Data to Improve Real-World Evidence Relevance and Reliability

(7/8, Carla Rodriguez-Watson, Rachele Hendricks-Sturrup, Martina Furegato, Lysel Brignol, The Evidence Base) comments “...Race and ethnicity data are not just about categories, they’re about people, context, history, and systems. If we want RWE to live up to its name, we must acknowledge the imperfections of these variables while also embracing their potential in our information age. That means improving methods, committing to transparency, leaning into complex information territory, and engaging in the communities we seek to serve.” Full

Aligning Contracts With The Goals Of Value-Based Care

(7/9, Theodore Chien, Forbes.com) comments “...In a value-based care model, programs like the Medicare Shared Savings Program (MSSP) encourage the formation of Accountable Care Organizations (ACOs) to coordinate care, improve outcomes and reduce spend while maintaining quality. Physicians who participate in shared savings programs receive a portion of the cost savings achieved through efficient care delivery. This element of compensation needs to be clearly defined in the employment contract.” Full

CMMI Model to Test Prior Authorization in Traditional Medicare

(7/9, David Raths, Healthcare Innovation) reports “...The Wasteful and Inappropriate Service Reduction (WISeR) model will use AI to review items and services that CMS deems vulnerable to fraud, waste and abuse...WISeR will exclude inpatient-only services, emergency services, and services that would pose a substantial risk to patients if substantially delayed. Although the model will use AI, CMS said all recommendations for non-payment will be determined by appropriately licensed clinicians who will apply standardized, transparent, and evidence-based procedures to their review.” Full