A strong business case exists for addressing the financial impacts of social determinants of health (SDoH) and new reimbursement models designed to emphasize health equity. Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy. This is because health disparities contribute more than $93 billion in unnecessary medical care costs and more than $42 billion annually…
Amid an uncertain economy, providers, payers, and patients alike will be turning their attention to value-based care models to cut costs and improve health outcomes. These models, where reimbursement is rewarded based on quality of care, have taken center stage once again in the healthcare discussion. During the pandemic, the industry saw a rapid move…
Jails can provide opportunities to diagnose and treat individuals for HIV. However, supporting care coordination for formerly incarcerated individuals upon reentry into the community can be difficult due to data sharing challenges. Current CDC guidelines for HIV care post-release recommend providing individuals with a 30-day supply of their HIV medication and an appointment with a…
Traditionally, healthcare in the U.S. has been based on a fee-for-service reimbursement model, where providers are paid for each service delivered to patients. The problem with this model is that pay is tied to volume, not outcomes— in fact, providers are incentivized to perform extra testing and procedures, emphasizing treatment at the expense of prevention…
When older adults consider enrolling in a Medicare Advantage (MA) health plan they may consider the plan’s Star Rating as a factor. Medicare’s Star Ratings program is designed to help older adults compare MA plans based on quality and performance. It is a scale from 1-5, with five being the highest, that considers quality and patient…
Primary care physician burnout got worse in developed nations around the world during the COVID-19 pandemic. The Commonwealth Fund published “Stressed Out and Burned Out: The Global Primary Care Crisis,” a survey of 9,526 physicians in the United States, Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom, from February…
It is no secret that health systems and hospitals have had a rough 2022 thus far. The pandemic led to increased operating expenses, and though COVID cases have steeply declined, the return of elective/non-urgent inpatient care has yet to fully recover. Health system leaders are working hard to flip the script and ensure patients are…
Download Slides Real social influencers are not found on YouTube® channels or Facebook® feeds. Instead, they are found in communities struggling with food insecurity, housing instability and homelessness, high rates of crime, social isolation, and lack of the most basic healthcare services. Since 2016, HealthEC® and the Prince George’s Healthcare Alliance© in Maryland have…
With the release of the 2023 Physician Fee Schedule Final Rule, CMS upheld its commitment to sunset its Web Interface for ACO quality reporting after 2024. Beginning in 2025, ACOs will be required to report through the Alternate Payment Model Performance Pathway, or APP. Some have expressed concerns about the APP. But this new reporting…
Despite its challenges, value-based care has shown great promise in improving health outcomes and access to care, particularly among traditionally underserved or high-risk patient populations. That was the view of participants in the panel discission, “The Risky Business of Value-Based Care” at the 2022 HLTH conference in Las Vegas. Panel moderator Sara Pinto, a partner…