Both the greatest strength and weakness of the ACO shared savings (MSSP) model is its focus on primary care, particularly chronic disease. ACOs have put patients with diabetes, hypertension, and other conditions usually handled through primary care physicians at the center of care coordination, population health, and care management. But as CMS Value-Based Care’s central…
Care New England Health System in Providence, R.I., has participated in value-based contracting for years with some success. But over the last 12 to 18 months, the health system has reframed how they think about “value” to serve the community better. “The Rhode Island landscape for value-based contracting has been financially challenging, and those pressures…
Mounting financial pressures, workforce shortages, and rising patient demand are pushing health systems to rethink how they deliver care. The traditional hospital-centered model is giving way to strategies that prioritize prevention, access, and efficiency. By embracing value-based care and new technologies, organizations aim to curb costly emergency visits, ease capacity strains, and deliver better outcomes…
Humana Healthcare Research has released new data showing that Medicare Advantage patients with heart failure who are treated by value-based care (VBC) physicians are significantly more likely to receive recommended therapies than those in traditional care models. According to Humana’s Value-Based Care Issue Brief, patients in VBC arrangements were nearly 28% more likely to receive full quadruple therapy —…
Using ambient AI scribe technology was associated with significant reductions in physician burnout and improvements in well-being, a new study published in JAMA Network Open reveals. The study, which includes survey data from Mass General Brigham (MGB) and Emory Healthcare, indicates that ambient AI scribe tools enhance clinician experience. These tools leverage generative AI to record patient-provider conversations during a clinical…
Rising costs, strained provider networks, and outdated administrative processes continue to destabilize the US health care system, leaving both patients and employers grappling with uncertainty. At the Greater Philadelphia Business Coalition on Health (GPBCH) annual conference, a session titled “Merge Ahead: The Health System and Payer Dynamic” brought together leaders from both the provider and payer sides to examine…
Download Slides The costs of specialty care have come under the public eye of Value-Based Health Care. As health care costs continue to escalate, CMS has been pivoting to higher risk vehicles to push for cost accountability among providers. One of these is TEAM, Transforming Episode Accountability Model, set to start in January, 2026….
The Center for Medicare and Medicaid Innovation (CMMI) recently released a new strategy to “Make America Healthy Again.” Broadly, this direction seeks to emphasize prevention, patient engagement, and empowering people to achieve their health goals. More specifically, the new strategy includes goals in three areas: increasing patient engagement, better leveraging data and patient engagement tools, and protecting…
In value-based care, nothing happens without access to robust data. It powers everything from advanced analytics to predictive AI models. It provides a holistic picture of population health and individual patient needs, informing appropriate care interventions that improve outcomes and reduce costs. As AI tools become more prevalent in healthcare generally, and in value-based care…
Surgery will be a financial winner or loser under TEAM (Transforming Episode Accountability Model), a mandatory episodic payment model beginning in January 2026. Let’s be clear: TEAM requires a tectonic plate shift in managing cost and outcomes of surgical procedures for five types of procedures. To be on the winning side of this model, your hospital…