How should health systems and insurers talk to policymakers, patients and plan members about the concept of value-based care? That was one of the questions addressed by a recent panel discussion hosted by the Duke Margolis Institute of Health Policy. Kevin Larsen, M.D., senior vice president of clinical innovation at Optum, and a former senior…
Boston-based Community Care Cooperative (C3), an accountable care organization (ACO) founded and governed by Federally Qualified Health Centers has added four more FQHCs to its network participating in the Centers for Medicare & Medicaid Services Medicare Shared Savings Program (MSSP). C3 announced that it has partnered with two FQHCs in California, one in the District…
For organizations hoping to draw out savings from value-based care, added administrative burdens might be a source of hesitation. However, some operators are successfully turning to technology offerings that maximize reimbursement, pinpoint essential data, and include platforms already used by referral partners and managed care organizations (MAOs). AI programs can help “tease out” some of…
Navina, an AI-enabled clinical intelligence platform for primary care providers, announced the close of a $55 million Series C funding round, bringing its total raise to $100 million. Growth Equity at Goldman Sachs Alternatives led the round, with participation from existing investors Vertex Ventures Israel, ALIVE and Grove Ventures. WHAT IT DOES Navina offers providers,…
Health insurer Humana and independent primary care network Aledade are expanding their partnership, extending services to rural health clinics and federally qualified health centers (FQHCs) with an eye toward achieving and sustaining value-based care. The expanded collaboration will provide upfront resources, support and a timeframe for success for FQHCs and rural health clinics in 26…
Download Slides CMS’ new mandatory episode-based payment model, the Transforming Episode Accountability Model (TEAM), is scheduled to begin Jan. 1, 2026, affecting reimbursement for five high-volume surgical procedures. Data is key for hospitals to prepare for TEAM and to understand how markets will be impacted throughout the nation. Key takeaways: Join our Mandatory CMS…
Boston-based Community Care Cooperative (C3), an accountable care organization (ACO) founded and governed by Federally Qualified Health Centers has added four more FQHCs to its network participating in the Centers for Medicare & Medicaid Services Medicare Shared Savings Program (MSSP). C3 announced that it has partnered with two FQHCs in California, one in the District…
After more than a decade of experimentation, the verdict on value-based payment (VBP) models is decidedly mixed—there have been modest improvements in spending and quality but without breakthrough success in driving better health outcomes and sustainable spending at scale. Without dramatic changes in strategies, VBP risks becoming a footnote to the urgent challenges facing the…
The healthcare industry is undergoing significant changes, with the shift toward value-based care (VBC) taking center stage. As the sector moves away from fee-for-service models, rising costs and evolving administrative models pose new challenges. However, policy reforms and interoperability standards are creating opportunities to improve patient outcomes, reduce costs and streamline administrative processes. Although the…
Imagine a healthcare organization committed to improving patient outcomes while controlling costs. They have the right intentions, yet gaps in care coordination lead to preventable hospital readmissions, and they struggle to meet the quality benchmarks required for value-based care contracts. The challenge? Their data is fragmented across multiple systems, making it difficult to gain a…