Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models. Industry advancements in value-based care (VBC) have resulted in a meaningful restructuring of health plan and provider organizations, processes and…
Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund. Full Article
Download Slides Accountable care organizations (ACOs) leverage data and population insights to mitigate risk and improve patient health outcomes, and this starts with access to preventive care. Gap closure programs for preventive care include services such as screenings, annual visits, vaccinations, and more. However, only 8% of U.S. adults receive recommended preventive care. First…
The different social determinants of health have different impacts on healthcare quality, utilization, and outcomes, with new Humana data showing that some SDOH are more closely related to poor care quality while others are more closely related to high healthcare utilization. For other SDOH, like social isolation and limited access to transportation, patients experience both…
On March 31, 2023, Centers for Medicare and Medicaid Services (CMS) released the annual 2024 Medicare Advantage and Part D Rate Announcement (Rate Notice), which is the final guidance on rates for Medicare Advantage in 2024. As we explained in our prior blog posts (here and here), one of the more substantial changes proposed for…
Health disparities aren’t just a result of the inequities in the healthcare system, but also other socioeconomic areas including housing, nutrition and education. To tackle these challenges, the healthcare industry is going to need to work with other sectors, declared Hans Kluge, regional director for Europe at the World Health Organization. “One of the big…
While there are endless trends to prognosticate about in the healthcare world, one that is near impossible to quarrel with is that the push to value-based care will not only continue, but accelerate. Amid all of the transformation, innovation and buzzwords in value-based care, one crucial area that is suspiciously absent is the emergency department. But…
Today, WHO is launching the Health Inequality Data Repository, the most comprehensive global collection of publicly available disaggregated data and evidence on population health and its determinants. The repository allows for tracking health inequalities across population groups and over time, by breaking down data according to group characteristics, ranging from education level to ethnicity. The…
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…