Takeaway Points We assessed trends in market share over time among short-term acute care hospitals participating in accountable care organizations (ACOs) and non-ACO participants. ACO participation was associated with an increase in mean market share. ACO participation was associated with additional market share gains in more (vs less) concentrated markets. More importantly, baseline (2011) market…
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) has released and are highlighting evaluation reports and publications. You can access reports by going to the evaluations and research reports page of the Innovation Center website. Bundled Payments for Care Improvement Advanced Model Evaluation of Model Year 5 (2022) – Key Takeaways:…
On July 4, President Donald J. Trump signed into law the legislation and spending plan known as the One Big Beautiful Bill Act (OBBBA). The bill has a number of effects across different sectors of the economy, including health care. This slideshow compiles some facts, figures and responses from a variety of sources that analyzed…
The traditional fee-for-service (FFS) healthcare model isn’t well-suited to meet the complex needs of patients with chronic illnesses including chronic kidney disease (CKD). As costs spiral and population health declines, value-based care (VBC) presents a solution that can reshape how the healthcare system approaches CKD management and can serve as a model for how we…
The healthcare industry’s landscape shifted dramatically with the implementation of the Transparency in Coverage (TiC) Final Rule. For compliance professionals navigating this regulatory terrain, understanding both the letter and spirit of these requirements has become essential – not just for avoiding penalties, but also for leveraging transparency as a strategic advantage. The Regulatory Foundation The…
A decade ago, the federal government launched its large-scale Medicare Access and CHIP Reauthorization Act (MACRA) in an attempt to move more physicians into value-based care to rein in exploding costs and improve care. In July, Medical Economics will release the second edition of Medical Economics Insider featuring an in-depth look at how successful MACRA has been and what…
Download Slides Are you prepared for heightened scrutiny from the Centers for Medicare & Medicaid Services (CMS)? CMS is dramatically amplifying its audit efforts, with a renewed focus on Medicare Advantage plans and Risk Adjustment Data Validation (RADV) audits. This is not just another day at the office—CMS is expanding its audit workforce, increasing…
Download Slides We are entering into a period of scarce health care resources, with less funding to support new developments but higher focus on cost control. Many reimbursement vehicles, both governmental and private health plans, will adopt risk-based reimbursement. How do providers manage the transition to risk payment models? Is it still prudent to…
In Alabama’s Black Belt, you can drive 60 to 90 miles without passing a single dental provider. According to the Alabama Department of Public Health, several counties—including Perry, Greene, Lowndes, and Wilcox—have one or no dentists at all. Residents often live with chronic pain, untreated infection, or shame so deep they stop smiling altogether. In policy…
Women primary care providers (PCPs) treating Medicare patients in a value-based care setting have equal or better patient outcomes than men PCPs in the same setting, despite having the same overall patient satisfaction rating, according to a recent study sponsored by agilon health, published May 16 in JAMA Health Forum. Women PCPs ranked higher than their men counterparts…
The last time The American Journal of Managed Care (AJMC) hosted a meeting in Princeton, New Jersey, was 2014, as millions of Americans were gaining health coverage under the Affordable Care Act—some for the first time in their lives. Across health care, people were trying to grasp a new concept called value-based care, which focused on delivering…
As the second half of 2025 approaches, hospitals and health systems are taking stock of their annual quality improvement initiatives and pushing forward. Three healthcare leaders shared with Becker’s the quality metrics they are tracking most closely, including efficient discharges and fall prevention. Question: Looking ahead to the second half of the year, what is one specific quality…