The simple definition of value-based care is better patient outcomes combined with smarter spending. As the U.S. healthcare system shifts from a fee-for-service model to incentivizing providers for improved care at a better price, there are specific practices in the ecosystem that must be addressed. Panel stuffing for lab tests is one of them. Panel…
Published in Circulation: Heart Failure, a recent study conducted by Northwestern Medicine researchers found that adding social determinants of health (SDOH) data into machine learning models led to less bias when predicting outcomes for heart failure patients. Healthcare bias can lead to detrimental outcomes for patients. For example, in April, a study published in PLOS digital health found that digital health…
Independence Blue Cross (Independence) has announced that it will renew its long-term value-based care contract with Jefferson Health. The provider will participate in Independence’s Total Value of Care value-based care program starting on January 1, 2023. Independence, a payer in southeastern Pennsylvania, has already been in a value-based care partnership with the non-profit health system and teaching…
Managed care contracts could be positioned as a valuable tool for state Medicaid programs seeking to promote racial equity. While contracts are far removed from the front lines of care, well-designed agreements between states and plans can begin the process of addressing inequities in the delivery of health care. States can use contractual provisions to…
Envision Healthcare, a leading national medical group, is continuing work to improve health equity by addressing social determinants of health (SDOH). The medical group’s new white paper details how clinicians and healthcare professionals can work together to improve medical care for all patients. SDOH are the economic, political and/or cultural forces that influence the health…
Health and well-being require far more than medical care. Research shows that personal behaviors, physical environments and socioeconomic factors—commonly referred to as social drivers of health (SDOH)—are responsible for 80 percent of health outcomes. Individuals enrolled in Medicaid experience disproportionate rates of complex health and social needs. With this in mind, state Medicaid agencies are…
Global health equity won’t be achieved until everyone—no matter who they are, where they live or what their means are—can access the best possible healthcare providers and treatments. Most people in regulated industries like data aggregation or healthcare are familiar with the EU’s General Data Protection Regulation (GDPR) of 2018, which is designed to protect…
For the first time, the Center for Medicare and Medicaid Services is proposing to establish a health equity index in the Medicare Advantage and Part D Star Ratings program that would reward excellent care for underserved populations. The proposed rule would also update the Medicare Part D medication therapy management program to require that plans include…
Value-based care has evolved into a healthcare landscape of its own, with a wide range of organizations contributing to systematic changes that improve quality of care and outcomes while better controlling costs. Providers specializing in value-based care have become attractive to investors because of the distinctive quality of care that they can provide and the…
Consumerism, autonomous operations, interoperability, healthcare access, health equity – these are some of the top issues facing healthcare CIOs and other health IT leaders in 2023, according to Pega Vice President of Healthcare Life Sciences Susan Taylor. We spoke with the health IT vendor executive to get her expert views and 2023 predictions on these…