Healthcare is undergoing a major shift. Rising costs, a growing number of chronic disease cases and an aging population have revealed the limitations of the traditional fee-for-service (FFS) model. Under FFS, providers are paid based on the volume of services rendered—regardless of the outcomes. This has led to inefficiencies, fragmented care and increasing financial pressure on both patients…
Women primary care physicians (PCPs) participating in full-risk Medicare Advantage (MA) value-based payment models earned more than their male counterparts and delivered better clinical outcomes, according to a new study published May 16 in JAMA Health Forum. The findings show a reversal of the well-documented gender pay gap in medicine, raising new questions about how different payment structures affect equity…
The term “value-based care” is tossed around like a political football among healthcare policy makers. Nowhere is the meaning of this so variable as in nursing homes. The Nursing Home Value-Based Purchasing Demonstration project, completed over a decade ago, was not found to lower spending or improve quality. Webster’s Dictionary defines value as “the monetary worth of something,”…
In today’s complex healthcare landscape, Physician Advisors (PAs) play an increasingly vital role in ensuring hospitals and health systems function smoothly, efficiently, and with a focus on patient-centered care. As healthcare spending continues to rise, the need for professionals who can effectively navigate the intersection of clinical practice and financial stewardship has never been greater. What is a Physician Advisor? Physician Advisors serve as…
The Center for Medicare and Medicaid Innovation (CMMI) announced its approach to President Donald Trump and Secretary Robert F. Kennedy’s call to “Make America Healthy Again” – and it promises to, among other aims, increase patients’ ability to receive care in the setting of their choice, including the home. The new strategy, announced Tuesday, also…
Download Slides Best Value-Based Care Strategies for A Cost-Focused Future Provider strategies for Value-Based Care participation will be significantly different under the new federal administration’s cost cutting agenda. Along with changes in Medicare Advantage’s position in the new CMS vision of Value-Based Care, there are fewer payment models and hints of other changes to come….
Through pay-for-reporting and pay-for-performance programs, payers such as the Centers for Medicare and Medicaid Services (CMS) rely on quality measures to incentivize and make inferences about care quality and evaluate the performance of health care delivery innovations. The growth of pay-for-performance and value-based care (VBC) programs in the United States drives demand for quality measures…
The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many value-based care models, accountable care organizations are among the most popular and successful models to date due to their emphasis on coordinated healthcare. These organizations not only facilitate seamless coordinated healthcare…
Philadelphia-based Jefferson Health — now a 32-hospital system after the 2024 acquisition of Lehigh Valley Health Network — is prioritizing integration and financial sustainability post-transaction. Joseph Cacchione, MD, who has been CEO for the last two and a half years, said the health system — which also includes a nearly 400,000-member health plan and a…
A value-based payment model can drive collaboration between primary care physicians and oncologists to provide the best possible care for patients, said a former leader at the U.S. Centers for Medicare & Medicaid Services. Elizabeth Fowler, JD, PhD, was a keynote speaker on May 6 at the 2025 NCCN Policy Summit: Primary Care and Oncology Collaboration…