In the News: May 9–16

UnitedHealthcare Bundles Payments for Maternity Care

A recent Modern Healthcare article discusses UnitedHealthcare’s shift toward a national bundled payment model for maternity care. UnitedHealthcare is following the lead of other national health insurance providers, including Cigna and Humana, which have provided the option for bundled payment for maternity care since early last year. Bundled payment models aim to reduce costs and improve the quality of pregnancy and childbirth services. The bundle begins once the mother is admitted to the hospital for labor, but it also ensures the provision of care during pregnancy and after delivery. Frequency of prenatal visits and timeliness of postpartum care are among the quality measures that will be examined and compared across the market. Pregnancy and childbirth services are ideal services for bundling because they are the most common reasons for hospitalizations in the United States and there is also significant variation in the cost of maternity-care services.

Sg2 continues to see a shift toward bundled payments, as episode-based payment models will stand the test of time. There are strong reasons for health systems to take advantage of bundled payment programs to advance their overall value-based payment strategy. Partnering with Sg2 and taking advantage of our bundled payment expertise and analytics capabilities can help you mine the raw CMS data and develop Bundled Payments for Care Improvement (BPCI) dashboards to help you visualize your performance and isolate your opportunities. To learn more on how to take advantage of BPCI Advanced for bundled payment success, watch the on-demand Sg2 webinar BPCI Advanced: The Time Is Now.

CMS Requires Drug Manufacturers to List Prices in Ads

A recent Modern Healthcare article describes the finalized rule by CMS that forces drug manufacturers to include the list price for their drugs in direct-to-consumer ads. This rule, which was first proposed in October, aims to increase transparency and is going into full effect in 60 days despite facing strong opposition from the pharmaceutical industry.

The new policy applies to both drugs and biologics with list prices exceeding $35 for a month supply or the typical duration of therapy for that treatment. The rule does not explicitly define how the list price should be included in the ad, but it does state that the price must be legible. Additionally, the policy does allow drug companies to state that insurance may change the price. While the FDA already oversees direct-to-consumer ads and punishes companies that violate the guidelines, CMS passed this specific policy and is relying on drug companies to regulate each other.

Health care continues to see increased transparency, especially regarding price of care and services. The results from the National Sg2 Consumerism survey represent over 25,000 consumer responses and reveal what consumers value when shopping for health care. The survey found that consumers’ biggest health care concern is the lack of affordable options. To learn more about consumer preferences and how they vary across generations and geographies, watch the on-demand Sg2 webinar Consumerism Update 2018: Sg2 Shares National Consumer Survey Highlights.

Employed Physicians Outpace Physician Practice Owners

A recent FierceHealthcare article highlights 2018 survey results from the American Medical Association showing that there are fewer physician practice owners (45.9%) than employees (47.4%). Although this is the first time employed physicians outnumber self-employed physicians, it was a much anticipated occurrence given the accelerating rate of change in the early 1990s.

Many physicians are employed by other doctors, with 54% of surveyed physicians working in physician-owned practices. Additionally, 34.7% of physicians are working for a practice fully or partially owned by a hospital or working directly for a hospital, up 29% from 2012. Younger physicians are primarily driving this trend, as 70% of physicians 40 years old or younger are employed.

Surgical subspecialties have the highest share of physician practice owners (64.5%) while family practices have the highest share of employed physicians (57.4%), which demonstrate that physicians recognize the shifting dynamics in health care and are reevaluating professional preferences toward independence or employment. Employment is one of many ways to align physicians with an organization, but this model may not be ideal for every organization. To learn more about the employment physician alignment model, read Sg2’s resource Physician Alignment Guide: Employment.

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