Most value-based payment programs have failed to significantly reduce healthcare spending or improve the quality of care for patients. Many have actually resulted in higher healthcare spending, and some have made it harder for patients with complex conditions to receive adequate care. The reason current programs have failed is that payers have tried to create…
Two physician healthcare policy leaders are offering an examination of the value-based delivery and payment movement in healthcare from a health equity perspective, and have concluded that, while healthcare reimbursement reform can provide one element in moving the needle on health equity, it alone cannot provide a vehicle that will transform the U.S. healthcare system…
The proposed changes in the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2023 may offer incentives for provider groups to consider alternative payment models. Still, the policies will likely require more apparent benefits to significantly impact the shift to value-based care. The CY 2023 PFS proposed rule included changes to the Medicare Shared…
The COVID-19 pandemic supercharged in-home care in the U.S. Suddenly it became possible to get a house call from a primary care provider; home-based physical therapy, dialysis, or an infusion of medicine; even a full complement of hospital-level services at home became possible. And Americans overwhelmingly liked it. The Centers for Medicare & Medicaid Services…
Download Slides ACO REACH participants face a number of new challenges starting January 1, 2023. CMS will require every participating ACO to have a health equity plan in place to successfully identify, engage, and intervene with socially vulnerable populations. Organizations will be measured and evaluated based on their ability to execute this health equity…
The CMS outlined potential guidance last week on issues like healthcare equity and climate change in its final inpatient payment rule as the federal government heightens its healthcare oversight on social issues. In the report, the CMS released comments that it received after soliciting public input during its proposed rule in April. The feedback on…
In any given community, the local health system is probably one of the biggest employers. It’s probably also one of the biggest spenders and biggest concentrations of social capital. The word for that is anchor institution, and healthcare organizations need to embrace that status in order to keep the health equity ship moving. For nearly…
Providers and payers are increasingly addressing the health-related social needs (HRSNs) of their patients to improve outcomes, reduce costs, and address health disparities. As this practice takes hold in the field, the landmark Accountable Health Communities (AHC) Model test that launched in 2017 has now ended. AHC was the Centers for Medicare and Medicaid Services’…
A new report, funded by the Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation and the Office of the National Coordinator for Health IT, summarizes interviews with executives at 21 organizations involved in value-based care. The report focuses on the barriers to and facilitators of data integration in support of value-based…
ACOs with independent participants have struggled with their highest performing practices being recruited by multi-ACO enabler entities. From the other perspective, provider practices are challenged with selecting from an increasing array of enabler contracts as alternatives to CMS’s BASIC, ENHANCED and REACH models. When making PY 2023 track decisions, affected ACOs and practices benefit from…