With the recent announcements of two new innovation models, the Centers for Medicare & Medicaid Services (CMS) is recognizing the role of digitally enabled care in improving access and outcomes. The Transforming Maternal Health (TMaH) model will issue cooperative agreements to up to 15 state Medicaid agencies to participate in a ten-year payment and care…
Over the past decade, the health care industry has shifted to value-based care, albeit on an incremental basis. These efforts deserve praise and are the result of intentional, hard work. Based on observations from the consulting team at FORVIS, we found that this shift is variable in maturity across key value-based areas. That is, organizations…
The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry’s digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS, Star Ratings, and the overall operational and financial health of provider networks. Impact…
Background A quick search online will show that most individuals go into the field of nursing for similar reasons; the National Institutes of Health (NIH) sums it up nicely, citing nurses have “…a desire to serve others…a personal calling…and a desire to work in the [healthcare] field with the sick, in a noble and caring…
A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were. The civil suit alleges that Aledade Inc.’s billing apps and other software and guidance…
Systemic racial biases persistently shape the health care experiences of Black, Latinx and Indigenous populations. These biases are especially pronounced for women of color, influencing everything from diagnosis and family planning to treatment recommendations. In fact, Centers for Disease Control and Prevention data show that Black women are two to three times more likely to…
The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. In 2023, VBC grew and evolved as healthcare providers, payers and policymakers sought to improve patient results while containing costs. Expect to see more of the same investments and trends in VBC…
Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That is a…
In the supermarket, we look for fish that’s sustainably raised. We’re swayed by sustainable practices from hotels and retailers. So why wouldn’t the same standard apply to the most important service industry in the world, healthcare? The fact is that the traditional fee-for-service model, charging patients and plans for every blood draw, X-ray, and surgery,…
Since the implementation of the Affordable Care Act, a major shift has been underway in how individuals in traditional Medicare receive their services. The Centers for Medicare and Medicaid Services (CMS) has been systematically developing programs that focus on providing value-based care (VBC) to these enrollees. These programs include the Medicare Shared Savings Program (MSSP);…