On July 1, 2022, the Federal Price Transparency Rule (the Rule) went into effect for commercial health plans. Under these requirements, certain health insurers must disclose their in-network negotiated rates as well as their out-of-network allowed rates. The insurers are required to publicly provide this data on their websites as machine-readable files (MRFs) that follow…
Private equity firms have increasingly been investing in the healthcare sector, seeking to capitalize on the industry’s growth potential and profitability. However, this trend has raised concerns over the potential impact on healthcare access and quality, as well as the ethics of profiting from healthcare services. The term “private equity” has been thrown around more…
The U.S. Centers for Medicare & Medicaid Services (CMS) is moving towards the development of health equity quality measures for hospices. Last year, the agency convened a technical expert panel (TEP) to study the issue, according to language in its 2024 proposed hospice rule. Among the questions the panel has considered is the addition of…
CMS finalized sweeping changes to risk adjustment for MSSP and REACH ACOs through the implementation of the V28 CMS-HCC model. Most immediately, the 2023 diagnosis collection year will use a blend of 33% for the V28 model and 67% for the prior V24 model. V28 will be deployed at 67% in 2024 and fully phased…
Accountable care organizations (ACOs) are provider contracting models intended to improve population health while controlling cost. With careful design and monitoring they can also serve as a platform for improving health equity. While much of the innovation and research related to ACOs has occurred in the context of Medicare and commercial insurance, Medicaid ACOs may…
In the ongoing shift from volume to value in US health care, primary care value-based alternative payment models (APMs), such as accountable care organizations, have dominated the landscape when compared to specialty care APMs. Interviews with hundreds of payers and clinicians across various specialties signal that there are ongoing challenges with investing in, designing, and…
Download Slides Years of ACO investments from providers and other stakeholders have managed to produce successful savings among many ACOs. But compelling economic success that substantially lowers aggregate Medicare costs – and generates revenue for providers – eludes ACOs. What does it take for your ACO to reach potential for top value, and become…
In value-based care, it takes a village of professionals to ensure patients are well cared for and practices meet benchmarks. Community health workers (CHWs) are emerging as key players in helping to achieve these goals. CHWs are nonclinical healthcare professionals who support patients’ physical, mental, and social needs by connecting them to community resources and…
Download Slides Providing post-acute services is a significant challenge for both payers and risk-bearing providers. In the 90 days following discharge from an acute care hospital, older patients are 6 times more likely to be hospitalized, 11 times more costly, and 9 times more likely to die. Given this, why is it that providers…
Physicians work hard to provide care that delivers the best possible outcomes to their patients. Unfortunately, their efforts haven’t always been appropriately recognized. I don’t mean that doctors are poorly compensated—although, like many workers, their salaries aren’t keeping up with inflation. The issue here is that they’re often incentivized to deliver more care rather than…