Like politics, it’s been said that all healthcare is local. But when it comes to the role of community-based organizations (CBO) in supporting health, payers and other stakeholders haven’t quite known how to include their closest neighbors. Add to this the rising importance of social determinants of health (SDOH), which CBOs may be qualified to…
Yet another benefit of the pandemic’s telehealth expansion is more hospital-at-home (HAH) and remote patient monitoring (RPM) programs. Integra Community Care Network, the accountable care organization (ACO) for Care New England Health System, is launching both in partnership with tech company Biofourmis. And with the Centers for Medicare & Medicaid Services (CMS) expanding HAH waiver…
As the Biden administration continues to move Medicare reimbursement from volume-based payment to payments based on value, officials are expanding those efforts to include providers who care for “traditional” Medicare patients and currently bill under a fee-for-service system. The new Direct Contracting program, a demonstration program that began under the Trump administration, allows “a broad…
The world of health care has changed a lot in the past decade, and the Center for Medicare and Medicaid Innovation (CMMI) at CMS has been behind a lot of that change. Radio Advisory’s Rachel Woods sat down with Liz Fowler, director of CMMI, to talk about what innovations CMMI has worked on in the…
Acquiring knowledge through advanced analytics on value-based care is a critical success factor in today’s healthcare market. Value-based care aligns diverse interests, including payers, providers, self-funded employers, third-party administrators, brokers, consultants, and patients—value-based care empowers them to deliver, manage, and drive higher patient outcomes while meaningfully managing and decreasing healthcare costs. A recent study of…
For better chronic disease management, Boston University researchers recommend replacing the term “race” with underlying factors that indicate an increased risk for heart attacks and strokes. “If other factors (instead of race itself) determine the risk differences, then the prediction equations should incorporate those factors that cause the differences in predicted risk between the races, rather than race itself….
The year 2021 has been a dramatic one for the evolution of alternative payment models (APMs) in U.S. healthcare, from every type of accountable care organization (ACO) to bundled payments, to the rollout of the Direct Contracting program for physician groups under Medicare. That has been true both in the public and private spaces, but…
Medicaid managed care organizations (MCOs) may be better equipped to address members’ social determinants of health and health equity compared to fee-for-service models, according to a report from Health Management Associates (HMA) and Together for Better Medicaid. State Medicaid programs send requests for proposals (RFPs) to managed care organizations when preparing to enter a new…
Despite major reports in 2019 and 2021 from National Academies of Science, Engineering, and Medicine (NASEM) calling on the integration of social care into healthcare delivery, the lack of payment reform has stymied efforts by clinicians and healthcare systems to address social barriers to care and social determinants of health (SDOH), according to authors in…
Though healthcare disparities are not new, the COVID-19 pandemic brought the starkest and glaring gaps in care to the forefront. While the healthcare industry and federal and local governments have in some ways stepped up to tackle health equity, experts agree there is still a long way to go. From the need for better data…