Verma: Patient Care, Payment Design Need Value-Based Reforms

From Health Payer Intelligence:

Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA).

During the AHA’s Annual Membership Meeting, Verma stressed that CMS is dedicated to promoting quality-based reimbursement, consumer-directed healthcare decisions, and cost transparency.

“Secretary Azar and I are working for competition and better value by moving away from a fee-for-service approach, to a system that is value-based – and that rewards value over volume,” Verma said. “This means paying providers on the outcomes they achieve, rather than how many procedures they perform.”

Verma said that CMS is developing new payment models to address challenges related to affordability and the cost of services.

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Health Plans That Use Member Enrollment Data to Push Their Political Agenda Might Violate HIPAA.

HEALTH PLAN WEEK is reporting is this weeks issue that health plans could face stiff penalties under HIPAA if they use enrollment information to contact members without their permission and urge them to join grassroots advocacy campaigns or take a stance on a political issue.

As a case in point the article cites a September incident where Humana Inc. pulled 900,000 names and addresses from its Medicare Advantage database and sent those beneficiaries letters recommending that they fight against proposed significant cuts to the MA program. CMS ordered Humana to cease all such mailings, which it says violated the health insurers Medicare contract. CMS also says the letters might have violated HIPAA, and asked the HHS Office for Civil Rights (OCR) to investigate

However, Jeff Drummond, apartner Dallas-based law firm, says Humana could defend the use of its enrollment data as falling into the HIPAA exemption for operations, contending this was an effort to communicate benefits information to its members, much like describing changes in a drug formulary, he tells HPW.

For more information visit the original article here.