The Center for Medicare and Medicaid Innovation (CMMI) within CMS is tasked with fostering “healthcare transformation by finding new ways to pay for and deliver care that can lower costs and improve care.” An important component of CMMI’s agenda is the accountable care organization (ACO) model in fee-for-service (FFS) traditional Medicare (TM). CMS defines ACOs…

As we move through the second half of 2024, managed care organizations must prioritize member engagement, especially for individuals with chronic conditions. This period presents an opportunity to embrace strategies that encourage essential healthcare visits, such as annual wellness and primary care appointments. Read on for member engagement tactics that focus on precise member identification,…

The healthcare industry has been buffeted by a growing number of challenges over the past few years. This turbulence struck provider organizations in 2022, while payers were initially sheltered from the storm (Exhibit 1). But conditions became more difficult for payers in 2023, which has continued into this year, and there’s limited respite on the…

In this interview, Gordon Kuntz discusses the Delphi Method, a Predictable Cost of Care Model developed by the Predictable Cost of Care Working Group that enhances oncology market access strategies by standardizing and broadening the economic modeling of cancer treatment costs beyond just drug prices, while aiming to inform pathway developers, payers, and practices. Full…

Value-based care places additional emphasis on improved patient health outcomes, rather than solely on the volume of services provided. Looking ahead to 2025, it’s important to understand how current trends with value-based care could impact the health care industry as a whole. Pradeep Kumar Jain is the senior director of analytics and the senior client…

Where Physician Burnout and Value-Based Care Intersect This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster the psychological safety and emotional well-being of their physicians. Our second post discussed artificial intelligence solutions as a potential way…

A year ago, Sentara Health rebranded itself and launched One Sentara, an initiative to better unite its healthcare and health plan businesses to deliver a more cohesive customer experience. Technology plays a pivotal role. Sentara’s IT team has migrated most data center workloads to Microsoft Azure and is integrating disparate patient care and health plan…