Value-based care (VBC) is a health care delivery model that has grown increasingly common in recent years. Perhaps unsurprisingly, this growth seems to have attracted the attention of government enforcement agencies. In September 2024, the Department of Justice (DOJ) announced a large False Claims Act (FCA) settlement with a VBC primary care practice. In December…
Clinical Documentation Improvement (CDI) programs play a vital role in Accountable Care Organizations (ACOs), ensuring accurate and comprehensive documentation that supports proper reimbursement, compliance, and quality patient care. With healthcare reimbursement models becoming increasingly complex, ACOs must implement strategies that streamline documentation, reduce errors, and align with Medicare’s risk adjustment models like Hierarchical Condition Category…
Value based care remains a top priority in health care, and physician practices of all types are feeling the pressure from payers to take on more risk. Despite this national trend, many physician practices have been slow to embrace these models, in part due to concerns about the ability to win in risk-based arrangements, while…
Health systems and ACOs: Prepare yourself for the return to cost containment as the central objective of Value-Based Care in 2025. While cost measures have always been part of CMS Value-Based Care quality programs, their impact was small relative to the total MIPS score for physician groups. Likewise, ACO savings look big in dollars but…
CMS has made substantial progress on its goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030. As of January 2025, 53.4% of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider. This represents more than…
The nation’s preeminent association supporting the development of accountable care organizations (ACOs) on Jan. 21 expressed satisfaction over the bipartisan introduction of legislation into the U.S. House of Representatives that would delay a requirement imposed by the Centers for Medicare & Medicaid Services (CMS) for ACOs to report electronic clinical quality measures (eCQMs); the CMS…
Download Slides In today’s valued-based landscape, Tampa General Hospital has utilized the power of data to transform the care journey for their patients and improve outcomes. In this webinar, you will hear about the hospital’s journey to data transparency and the pivotal drivers that led them to focus on patient engagement, provider collaboration,…
With mandatory Alternative Payment Model Performance Pathway (APP) Reporting beginning in Performance Year 2025, the time to act is now. Reporting quality on all beneficiaries marks a major shift, requiring thoughtful preparation and strategic planning. If your Accountable Care Organization (ACO) hasn’t started yet, don’t worry — there’s still time to get on track. The…
From AI-powered diagnostics to personalized medicine, we asked twenty four healthcare executives their insights on trends and technologies that will transform patient care in the coming year. In 2025, Artificial Intelligence and the T.E.A.M. (Transforming Episode-Based Accountable Management) model will redefine care coordination, creating a smarter, faster, and more equitable healthcare system. Primary care will…
Insurance giant UnitedHealth Group (NYSE: UNH) is blaming providers and drug companies for the growing costs of health care in the U.S. This came after the company faced a wave of public scrutiny for its denial practices following the tragic death of Brian Thompson, CEO of its insurance arm, UnitedHealthcare. “Fundamentally, healthcare costs more in…