There is substantial variation and low correlation in healthcare spending across Medicare, Medicaid, and private insurance plans within different US regions, a study published in JAMA Network Open found. The US spends around $3.8 trillion per year on healthcare funded by Medicare, Medicaid, and private insurers. However, spending and healthcare utilization are rarely the same…
There’s a lot of buzz in healthcare about the promise of value-based care (VBC) and how it can reign in skyrocketing costs, while delivering improved patient outcomes. And indeed, the move to VBC has yielded positive results in primary care and there are emerging alternative payment models in specialty care for other chronic conditions. So it’s only natural that VBC has…
Existing diabetes quality metrics do not currently help patients improve their health and diabetes quality measurement must be improved through the adoption of new measures and modernization, according to a June report published in Health Affairs. Current quality measures do not safeguard against inappropriate treatment or overtreatment and in fact incentivize providers to focus on…
As the nation’s largest health care payer, responsible for more than one in five dollars spent on health care within the United States, Medicare plays a key role in transitioning the health care system away from fee-for-service, which incentivizes quantity of care, and towards value-based care, which incentivizes high-quality care and smarter spending. The passage…
The Centers for Medicare & Medicaid Services (CMS) released its first ever home- and community-based services (HCBS) quality measures Thursday. The agency said the measures will promote “consistent quality measurement within and across state Medicaid HCBS programs” and are a “critical step to promoting health equity among the millions of older adults and people with…
While the Centers for Medicare & Medicaid Services (CMS) proposes to make some of the most significant changes to its accountable care organization (ACO) model since it was finalized in 2011, it doesn’t appear that such updates will have a lasting impact on the broader skilled nursing industry. If anything, only operators with their own…
Alternative payment models that put financial risk on healthcare providers improved care quality for patients with diabetes more so than fee-for-service and incentive payment programs, according to a new study published in Health Affairs. “Models that place greater financial risk on providers, such as global payment and shared savings, tend to demonstrate greater improvements in…
Over the past few years, we have seen an increase in tech-based approaches to improving maternal outcomes and the birthing journey. While most women still have in-person visits to check the progress of their pregnancy, deliver or check-in following delivery, technology can expand the reach of health care services. Digital solutions, including remote patient monitoring,…
The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and “COVID-19-related challenges to practice sustainability.” The proposed 2023 Physician Fee Schedule (PFS) conversion factor is $33.08, a decrease of $1.53…
How you ramp-up to full-scale APMs is crucial. Even if your multi-specialty group or health system receives some value-based payments with downside risk, your success hinges both on financial viability and retention of your clinicians and patients. If you delay APM adoption only after reviewing the potential on your bottom line, you’ll need to pay…