What We’re Watching: January 21, 2020

COMING ATTRACTIONS

Health Affairs published our CEO, Susan DeVore’s annual trends forecast.

What we’re saying: Susan outlines five expectations for the changes 2020 will bring to healthcare.

1. A push toward Medicare Advantage-style payment across federal reimbursement programs
2. A combination of regulatory and market solutions will result in a significant reduction in drug shortages
3. Increased number of employers playing an even more active role in directly negotiating and contracting for better, more reliable services at a predictable cost for geographically diverse workforces
4. New rules from the Office of the National Coordinator (ONC) to mandate open application program interfaces that would enable a much more streamlined process for developing and bringing apps to the market
5. The launch of a national demonstration of maternal bundles through the Center for Medicare & Medicaid Innovation, leveraging the work that’s already been done by forward-thinking organizations to define the episode, affected providers, and cost and quality targets

Last week Bertha Coombs published a piece on how healthcare companies are using data and technology to boost primary care services, also featuring insights from Susan.

A WORLD WITHOUT DRUG SHORTAGES

We know that shortages of some generic injectable medications continue to impact the way care is delivered across the country. Our President, Michael J. Alkire, recently filmed a video with MarketWatch to give some background on the shortage issue, its causes and effects.

What we’re saying: Premier launched ProvideGx to solve the problem of drug shortages. Tremendous progress has already been made, with more than half of our members signing on to participate and more than 15 shortage drugs brought to market. We support the federal policy solutions in the Mitigating Emergency Drug Shortages (MEDS) Act (S. 2723) to help put an end to drug shortages.

LET’S TALK ABOUT ACOs

In another Health Affairs blog last week, CMS Administrator Seema Verma praised the doubling of the number of accountable care organizations (ACOs) taking on risk in the Medicare Shared Savings Program (MSSP) over the last year, increasing from 93 at the start of 2019 to 192 at the start of 2020. Verma also reported that 76 percent of the ACOs participating in the Next Generation ACO (NGACO) model in 2018 had achieved savings.

What we’re saying: Premier’s Population Health Management Collaborative members generated more than $70 million in savings to Medicare in the NGACO model in 2018, resulting in more than $63 million in shared savings payments. We’re working to make Medicare ACO models more successful in a number of ways by advocating to make the NGACO model a permanent, voluntary program and advating for a level playing field between all types of ACOs in the MSSP. While Verma argues that physician-led or “low-revenue” ACOs in the MSSP achieve higher savings for the Medicare program than hospital-led ACOs, Premier has found that:

• Many low-revenue ACOs actually collaborate with hospitals
• There’s no difference in performance between ACOs with and without hospitals
• It is in the patient’s interest to know that an ACO is not avoiding hospitalization

THE TIME FOR ELECTRONIC PRIOR AUTHORIZATION IS NOW

A study suggests that transitioning to fully electronic prior authorization (ePA) transactions could save the medical industry $454 million annually. For example, providers’ cost of manually processing prior authorizations jumped from $6.61 per-transaction in 2018 to $10.92 in 2019. ePA can also save providers as much as 17 minutes per transaction, allowing more time for patient care. Despite these savings opportunities, industry adoption of ePA was only 13% in 2019. Additionally, a new report funded by the “Big 3” automakers and their unions reviewed evidence on the cost of PA, finding that it runs between $2,200 and $3,400 annually (in 2010 dollars). The report concludes that PA should be standardized, streamlined, and automated and that targeting the requirements is the best approach to decreasing the burden and increasing the net benefit of PA programs.

What we’re saying: Premier is supporting the Improving Seniors’ Timely Access to Care Act of 2019 (HR 3107), which requires Medicare Advantage plans to use ePA and meet other CMS-established standards. Stanson Health, Premier’s clinical decision support tool, is developing an ePA solution that is expected to significantly reduce administrative burden and costs.

IN CASE YOU MISSED IT

1. Leave No Stone Unturned for Long-Term Supply Chain Efficiency
2. Here's why drug shortages cost the U.S. 450 million a year
3. Outcome-based contracts likely to keep growing, evolving despite challenges
4. Healthcare Forecast 2020: What Board Members and Senior Leaders Need to Know
5. Premier Shares Successful Efforts in the Fight Against Antimicrobial Resistance at Duke Margolis Health Policy Center Event
6. Are Your Clinicians Pre-PAMAed?
7. Four Ways to Approach the Medical Device Sterilization Predicament in an Election Year
8. Statement on the House Energy and Commerce Oversight and Investigations Subcommittee Hearing on State Efforts to Curb the Opioid Crisis
9. Five Health Care Trends for 2020
10. Premier Statement on Next Generation ACO Model Results
11. Healthcare Companies use Technology and Data to Boost Primary Care Services
12. What’s on Your Priority List for BPCI Advanced?
13. Embrace Disruption to Turn Financial Pressures Into Opportunities
14. Getting the Right Dose
15. Complications Increase Vaginal Delivery Costs By 20%, Study Finds
16. Rise in Delivery Complications is Increasing Hospital Costs
17. Complications & Common Chronic Conditions Increase Hospitals’ Childbirth Costs by 20 Percent or More
18. Saving Seconds by Solving the Emergency Syringe Shortage

What We’re Watching is a bi-weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out our last update!