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….
The Medicare Shared Savings Program (MSSP) continues to deliver meaningful savings while supporting high-quality health care, according to CMS.1 In 2023, the program saved Medicare more than $2.1 billion, while Shared Savings program Accountable Care Organizations (ACOs) helped deliver high-quality care and support CMS policies to enhance primary care, expand access to accountable care to…
In the wake of an important update from the Centers for Medicare & Medicaid Services (CMS) on the Medicare Shared Savings Program (MSSP), one of the nation’s leading associations representing physician groups involved in value-based contracting has released a press release focusing on the strong contribution of medical groups focused on primary care, to that…
The news coming out of the Centers for Medicare & Medicaid Services (CMS) this week was all good. What might that mean in the context of an uncertain and complex political landscape around healthcare generally and around value-based contracting more specifically? Well, to begin with, the news coming out of the federal government on Oct….
Prevention is better than cure — this age-old adage continues to guide the healthcare industry as it moves from volume-driven to value-based care models. In value-based care models, healthcare providers are paid based on the quality of care they provide, measured by clinical outcomes, patient and provider experience and the cost of care. According to…