Medicaid managed care organizations can leverage financial bonds to help increase funds for social determinants of health interventions and avoid underinvesting, according to research published in Health Affairs. Social determinants of health, including food insecurity, transportation barriers, and housing instability, can impact health equity and lead to avoidable health outcomes and spending. Interventions to address…
Health care providers looking to explore or expand their involvement in value-based care through affiliation with an accountable care organization (ACO) have a large number of options available to them. In the Medicare space, many providers find themselves being courted by ACOs participating either in the Medicare Shared Savings Program (MSSP), or the recently implemented…
Accountable Care Organizations (ACOs) are a payment and delivery model designed to incentivize the provision of high-quality care at lower cost. Evidence of reduced spending in Medicare ACOs compared to traditional payment models has prompted states to experiment with the use of ACOs in their Medicaid programs. Preliminary reports from Medicaid ACOs have shown a…
Care coordination is essential for patients with chronic diseases whose treatment plans require provider input from multiple specialties. Treatment for diabetes—one of the most expensive chronic diseases in the US—may incorporate care from over ten kinds of healthcare professionals. If these providers have poor communication, they can make a patient’s diabetes treatment plan even more…
When the covid-19 pandemic swept the country in early 2020 and emptied doctors’ offices nationwide, telemedicine was suddenly thrust into the spotlight. Patients and their physicians turned to virtual visits by video or phone rather than risk meeting face-to-face. During the early months of the pandemic, telehealth visits for care exploded. “It was a dramatic shift…
In October of 2021, CMS’s Center for Medicare and Medicaid Innovation (CMMI) released their Ten-Year Strategic Plan which has five main pillars, one of which is Advancing Health Equity. They also outlined one of their key goals, to have all Medicare beneficiaries in some form of accountable care relationship by 2030. Achieving this goal will…
High-quality primary care is a critical tool to advance health equity within Medicaid, which includes many enrollees who identify as people of color. This population experiences long-standing health inequities due to factors including structural racism and historic underinvestment in safety-net institutions. To support higher-quality, more equitable primary care, there is growing consensus that payment reform…
Many ACOs are in the throes of planning to adopt APP Reporting. It’s a massive undertaking that can be costly, depending on your ACO’s configuration of practices. If your ACO is scrambling to sort this out, you’re not alone in your abrupt initiation into the world of EHR data. Welcome to the joy ride. In…
As nursing home advocates continue to push for ending the 3-day hospital stay requirement, a recently released federal agency report on the use of these waivers by accountable care organizations (ACOs) showcases some of the benefits that they have brought to patients and providers. Use of waivers by ACOs for a 3-day stay did not…
It’s no secret that something needs to be done in order to curb the unsustainable increase in Medicare spending. In 2021, overall Medicare cost grew 8.4%, or 21% of total national health expenditure, greatly exceeding the pace of economic expansion and in turn threatening the long-term financial viability of the program. The Centers for Medicare & Medicaid…