Download Slides Specialty costs have long been a gnarly issue for ACOs, which currently have no ability to either steer or manage specialty costs. But Change is in the air, and it’s coming through ASM and TEAM, two large-scale specialty care risk payment models. Both payment models require referrals to primary care physicians for…
Physicians told Becker’s that the next major shift in medicine won’t be a new device or breakthrough drug, but the accelerating shift from fee-for-service to value-based purchasing. Cost pressures, patient frustration and employer fatigue are converging in ways that may force a structural reset in how physicians practice and get paid, several said. Steven Rich, MD, a…
Download Slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…
Download slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…
Value-based care represents one of health care’s most important transformations, driving hospitals and health systems to focus on outcomes that truly matter. To succeed in this model, organizations must track and improve their performance metrics continuously, making data health care’s most valuable currency. It is the foundation for improving patient care, reducing complications, and optimizing…
Value-based care continues to account for a substantial share of U.S. healthcare payments, underscoring sustained payer investment in payment models that link reimbursement to quality and cost outcomes. The findings come from a survey released by AHIP in collaboration with the Centers for Medicare and Medicaid Services. Danielle Lloyd, M.P.H., AHIP’s senior vice president of private market…
The CMS TEAM payment model focuses on the patient surgery and recovery process, which puts hospitals at risk for both cost and quality of surgeries. The end result of TEAM, if implemented well by hospitals and clinicians, is benefits for patients, with more coordination of services and fewer complications. The American College of Surgeons supports…
CMS released participation data Feb. 4 for Medicare accountable care organizations in 2026, showing continued growth in enrollment and a record number of beneficiaries served by the Shared Savings Program. Six things to know: An estimated 14.3 million Medicare beneficiaries are receiving care coordinated by ACOs as of January 2026, up from 13.7 million in 2025, a…
The Centers for Medicare & Medicaid Services (CMS) is moving steadily toward the use of FHIR-based digital quality measures (dQMs). CMS believes dQMs will enable a more dynamic, interoperable, and comprehensive approach to quality measurement than the electronic clinical quality measures (eCQMs) currently in use. As it seeks public feedback on draft dQM packages, CMS officials held…
What You Should Know The Report: Humana’s newly released Value-Based Care By the Numbers Report, reveals that Medicare Advantage members in value-based care (VBC) arrangements are seeing significantly better outcomes than those in traditional models. The Data: The impact is measurable and massive: VBC patients experienced 24.3% fewer hospital admissions and 13.4% fewer emergency room visits in 2024. The Shift: The report…
On January 1, 2026, approximately 700 hospitals across the United States began mandatory participation in the Centers for Medicare & Medicaid Services’ (CMS’) Transforming Episode Accountability Model (TEAM). TEAM is CMS’ new bundled payment model where participants will be taking on financial risk for the costs and quality outcomes of Medicare fee-for-service (FFS) beneficiaries undergoing…
Humana saw a 24.3% decrease in inpatient admissions, or a 229,000-stay dip, for Medicare Advantage members in value-based care arrangements versus those in traditional Medicare in 2024, according to Humana’s “12th Annual Value-based Care Report,” published Feb. 4. Humana reviewed 2024 data to evaluate outcomes for its Medicare Advantage members. Seventy-one percent of Humana individual MA members…