University Hospitals’ accountable care organization had a math problem: More than 64,000 diabetic patients and only a few endocrinologists. Besides the lack of available endocrinologists, there is a warped perception of who should care for the estimated 129 million Americans with at least one chronic disease, according to Peter Pronovost, MD, PhD. “Across America, the…
LOUISVILLE, Ky.–(BUSINESS WIRE)–Value-based care results in patients spending more time with their primary care clinician, less time in the hospital, and more frequent preventive care, based on research released today by leading health and well-being company Humana Inc. (NYSE: HUM) in its annual Value-Based Care Report. The report’s data shows that Medicare Advantage (MA) patients…
Primary care physicians (PCPs) practicing in value-based care (VBC) practice models spend more time with patients, reduce unnecessary hospitalizations and demonstrate more frequent preventive care, according to Humana’s 11th annual Value-Based Care Report released Wednesday. “Coordinated care that delivers the right care at the right time must become the standard,” Kate Goodrich, MD, MHS, chief…
With the value-based care (VBC) market predicted to grow to $43.4 billion by 2031, this healthcare model continues to gain momentum, prioritizing patient-centered, outcome-focused approaches. Personalized care addresses the shortcomings of traditional fee-for-service models, which have long prioritized treatment volume over patient outcomes, further driving up costs while often failing to improve long-term patient health….
Every year brings changes to the skilled nursing industry, and operators entered 2025 with many new elements on their plate. This is where Forvis Mazars comes in. The professional services network works with providers, hospitals, physicians’ offices and community health centers (CHCs), providing financial and consultative services. Their focus this year includes changes to the…
Download Slides Cost control has been one of the central objectives of Value-Based Care. Providers in ACOs and other APMs are participating in a variety of payment models with a cost control objective that is sometimes seen as secondary to other objectives. Under the upcoming politics of less government and less regulation, however, cost…
Value-based care has had several false starts over the years. But in the next year, several health systems are determined to make progress toward a payment system prizing pay for outcomes over volume. “Our No. 1 organizational change in 2025 is a substantial shift from fee for service to value-based care,” said Danielle Scheurer, MD,…
The Centers for Medicare and Medicaid Services (CMS) has set an ambitious goal to fully transition from fee-for-service models to value-based care by 2030. However, according to Anders Gilberg, Senior Vice President of Government Affairs for the Medical Group Management Association (MGMA), this shift will require significant effort and face numerous obstacles, as he told…
Download Slides Discover the keys to mastering value-based care contracts in this informative webinar! Join industry experts as they delve into effective strategies for contract negotiations, year-round performance tracking, and actionable approaches to streamline contract management in value-based arrangements. Gain valuable insights into measuring and comparing performance across multiple contracts to ensure alignment with…
Value-based care (VBC) is a health care delivery model that has grown increasingly common in recent years. Perhaps unsurprisingly, this growth seems to have attracted the attention of government enforcement agencies. In September 2024, the Department of Justice (DOJ) announced a large False Claims Act (FCA) settlement with a VBC primary care practice. In December…
Clinical Documentation Improvement (CDI) programs play a vital role in Accountable Care Organizations (ACOs), ensuring accurate and comprehensive documentation that supports proper reimbursement, compliance, and quality patient care. With healthcare reimbursement models becoming increasingly complex, ACOs must implement strategies that streamline documentation, reduce errors, and align with Medicare’s risk adjustment models like Hierarchical Condition Category…
Value based care remains a top priority in health care, and physician practices of all types are feeling the pressure from payers to take on more risk. Despite this national trend, many physician practices have been slow to embrace these models, in part due to concerns about the ability to win in risk-based arrangements, while…