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…
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…