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In the News: May 31–June 7

CMS’s Comprehensive Primary Care Initiative Improves Care Delivery

A recent Health Affairs analysis found that CMS’s Comprehensive Primary Care (CPC) initiative—with the participation of 38 public and private payers as well as CMS—improved primary care delivery across several measures but did not appreciably reduce Medicare spending or increase quality of care. Launched in 2012, the 4-year initiative intended to test whether the multipayer model would lower costs and achieve better health outcomes in 502 practices across 7 states and serves as the foundation for CPC+, a 5-year primary care medical home model launched in 2017.

The updated results, which included data from all 4 years of the initiative, showed increased access, better coordination of care transitions, and improvements in care delivery and care management for high-risk patients. The initiative also reduced growth in ED visits by 2% but did not cut Medicare spending enough to compensate for care management fees. Furthermore, there was no significant improvement in practice performance or physician and beneficiary experience.

Both public and private payers are increasingly experimenting with ways to add value to primary care delivery while cutting costs. Sg2 believes that as markets transform toward value-based care, organizations must understand their individual market and payer strategies to optimize primary care models. For more on how to prepare for the transition to value in your market, check out the Sg2 Expert Insight Does Recent Disruption Require a New Look at Primary Care?


Severity and Price of ED Visits Has Increased Despite Flat Visit Growth

A recent Modern Healthcare article highlights a study by the Health Care Cost Institute (HCCI) that found ED spending per member almost doubled from 2009 to 2016 due to increasing severity of ED visits and rising prices associated with those visits. HCCI analyzed 7 years of employer-sponsored insurance claims (~11.8 claims/year) for the 5 procedure codes used to bill ED visits, starting with Level 1 codes representing low-acuity conditions and moving up to Level 5 codes representing the most serious conditions.

HCCI found use of the highest-severity codes increased despite overall ED use staying the same. The average prices for each of the 5 codes increased, with ED visit spending per person rising to an average of $247 in 2016, up from $125 in 2009. HCCI noted that ED spending increased in every state despite ED visits growing in only 11 states.

Overall flat growth in ED volumes and the rising acuity of ED patients has been driven by lower-acuity patients seeking care at alternative, lower-cost care sites. Over the next decade, Sg2 projects emergent visits to grow by 10%, surpassing nonemergent ED visits in volume and leading to a higher-acuity ED patient population, with only 1% growth in ED volumes overall. For more utilization projections over the next decade, read the recent Sg2 Expert Insight Sg2 2018 Impact of Change Forecast: Rising Acuity Impacts Utilization.


Best Buy’s New Program Focuses on Home Monitoring for the Elderly

Best Buy recently announced a new health and wellness program that intends to use the mobile web, sensors and other digital home health care technology to allow family members or caregivers to remotely check in on aging family members at home. Best Buy will offer an entry-level package of digital home health technology for under $400 and a $29 monthly monitoring service.

The program is being piloted in Minneapolis and Denver, with no details on when a full-scale rollout may occur. This announcement, as well as Best Buy’s recent hiring of former CVS Health Chief Digital Officer Brian Tilzer, signals the company’s intention to move into the $48 billion connected health care market.

The introduction of the Internet of Things (IoT) is the next step in patient monitoring, taking everyday objects that will track, send and receive ongoing data on patients’ health. While IoT in patient monitoring is still in early development, Sg2 believes that organizations should begin discussions on how to best prepare for this fast-approaching future. For more on how IoT may change health care, both inside and outside the hospital, read the Sg2 Expert Insight The Internet of Things Will Radically Change Health Care: Are You Ready?

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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