As the industry shifts from volume to value based models, it is becoming necessary for Pharmaceutical companies to demonstrate the value their brands deliver through outcomes and evidence based studies. One example of such study is economic burden of inadequate symptom control.
As the industry shifts from volume to value based models, it is becoming necessary for Pharmaceutical companies to demonstrate the value their brands deliver through outcomes and evidence based studies. One example of such study is the economic burden of disease.
Improving the quality of care and services to patients and enrollees is one of the key imperatives of Affordable Care Act (ACA). Several initiatives and measures have been put in place to make this imperative an operational reality across the entire healthcare landscape. CMS has posted quality ratings of Medicare Advantage plans (STAR Ratings) to help Medicare beneficiaries. All Medicare Advantage plans are rated on a one-to-five-star scale, with one star for poor performance, three for average, and five for excellent. Plan’s bonus payments are attached to STAR rating. CMS will have the authority to use its discretion to terminate the contracts of Part C and D sponsors that fail to achieve at-least a 3-star plan rating for 3 consecutive years beginning 2015. However, financial benefit and penalties represent only one dimension of the importance and relevance of the Medicare STAR ratings. It has also evolved into a key competitive advantage for the plans competing for Medicare beneficiaries. By design of Medicare STAR rating, any eligible Medicare beneficiaries can switch over to a 5 star rating plan any time during the year and not only during the open enrollment period. This is an immense advantage for performing plans!!
An Accountable Care Organization (ACO) is a group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. The goal of the ACO is to deliver coordinated and efficient care. ACOs that achieve quality and cost targets (determined by Medicare) will receive a financial bonus based on selected “Risk Sharing Model”, and under some approaches, those that fail will be subject to a financial penalty.