Providers and payers play key roles in healthcare delivery. More often than not, the two must collaborate to ensure that patients and beneficiaries move through their care journeys as efficiently as possible while complying with state and federal regulations. Despite this shared goal, the relationship between providers and payers can be strained by information exchange…
Federally Qualified Health Centers (FQHCs) are a breed apart. Incorporating multispecialty practices with primary care, behavioral health, and even dental care, these 1,400 providers across the US see some 30 million Americans a year, many insured by Medicare and Medicaid. One such FQHC, Cherry Health, covering western Michigan and headquartered in Grand Rapids, serves more…
On Dec. 12, Elizabeth Fowler, Ph.D., J.D., the director of the Center for Medicare and Medicaid Innovation (CMMI), engaged in a lively Q&A with the Penn Medicine community in Philadelphia moderated by Rachel Werner, M.D., PhD., the executive director of Penn’s Leonard Davis Institute of Health Economics. Fowler began by talking about several projects currently…
Federally Qualified Health Centers (FQHCs) are a breed apart. Incorporating multispecialty practices with primary care, behavioral health, and even dental care, these 1,400 providers across the US see some 30 million Americans a year, many insured by Medicare and Medicaid. One such FQHC, Cherry Health, covering western Michigan and headquartered in Grand Rapids, serves more…
After an intense few years in health care, will 2023 deliver more punches? While 2022 was dubbed a COVID “recovery” year, as patient volume rebounded, health care staffing shortages festered. Burnout prompted physicians to retire, sell practices to corporate owners, or leave traditional health care for other employment. Simply put, 2022 was short on recovery…
The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its progress. These model tests have impacted the lives of millions of patients. In the two-year period covering the report,…
Download Slides CMS has released the Final Rule for 2023, and there’s plenty to unpack. Do you know how the new rules and updates will affect your organization? Is your ACO prepared for the end of the Web Interface and all-patient all-payer quality reporting? Is your organization using data effectively to overcome challenges and…
All stakeholders in the healthcare industry have gotten better at patient engagement in the past few years, as value-based care models have made it imperative that patients are involved in their own care management. But as more voices enter the conversation, it’s critical that there’s some coordination between both the payer and the provider, according…
The Medicare Merit-based Incentive Payment System (MIPS) unfairly penalizes physicians caring for a patient population with more complex medical needs, according to a study in JAMA Network. MIPS, the largest value-based payment system in the U.S., pays about 1 million physicians who care for Medicare patients based on scores in four categories: cost, quality, improvement…
Organizations’ net savings in the first year of a Medicare accountable care model varied widely, spotlighting the difficulties of delivering value-based care, where just a few sick patients or a substandard operational model can significantly skew results, experts say. Direct contracting entities in the Global and Professional Direct Contracting Model had a roughly 2% net…