The connection between behavioral health and physical health is well-documented. Physical health is greatly affected by such behaviors as smoking, substance abuse, poor diet, lack of exercise, insufficient sleep and more. In addition, mental health issues and social determinants of health, such as lack of housing or transportation, language barriers, and food insecurity, impact health….
Value-based care has been heralded as the future of healthcare for more than a decade, but it has yet to fully arrive. This gap is particularly evident in primary care, which must be on board if the promise of value-based care (VBC) is to be achieved. The Commonwealth Fund, a private U.S. foundation dedicated to…
With one year remaining before mandatory APP Reporting in 2026, the idea that you’re already late may sound exaggerated. But consider the significance of what you’re undertaking: This is your first effort to report quality on all your beneficiaries, not just a tiny sliver of patients. It’s a huge leap that requires a lot of…
Many healthcare leaders were elated when officials at the Centers for Medicare & Medicaid Services (CMS) on October 29 released the 2023 calendar-year results for the Medicare Shared Savings Program (MSSP), the program run by the Medicare program with the largest number of participating accountable care organizations (ACOs). As the press release from CMS on…
The healthcare industry is at a crossroads, grappling with the dual challenges of declining health quality metrics and skyrocketing care costs. The reality is that health outcomes are driven more by what patients do than by what providers or payers do. It is estimated that 80% of health outcomes are driven by non-medical factors –…
Dive Brief: Medicare’s largest value-based care program saved the government more than $2.1 billion last year — an all-time record, according to the CMS. Accountable care organizations, groups of providers that join together to manage the care of a patient population, also benefited, receiving performance payments of $3.1 billion in 2023. That’s also a historic high since…
If you’re participating in the Merit-based Incentive Payment System (MIPS) or MIPS Value Pathways (MVPs), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final score, the numbers don’t quite add up. For many providers, this discrepancy can lead…
Value-based care is transforming the health care landscape as some health systems shift focus toward outcomes-driven payment models. In this evolving paradigm, physicians and other health professionals are rewarded for improving patient health outcomes rather than the volume of services they deliver. This shift is designed to enhance care quality, reduce costs and improve patient…
Medicare Advantage (MA) star ratings have become a hot topic for Humana Inc. (NYSE: HUM). On Oct. 18, the company filed a lawsuit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) over its drop in star ratings. The number of Humana MA plans rated…
The Medicare Shared Savings Program achieved over $2.1 billion in net savings for Medicare in 2023 — the largest savings in its decade-long history, according to the Centers for Medicare & Medicaid Services (CMS). In addition to cost savings, Accountable Care Organizations (ACOs) participating in the program have raised the bar in quality of care….