The famous quote “What gets measured, gets managed” is often incorrectly attributed to business guru Peter Drucker. Although Drucker may not believe that maxim entirely, when it comes to value-based care (VBC), only care quality that can be measured and reported matters. Whether it is capitated, bundled, pay-for-performance, or hybrid VBC reimbursement models, the Centers…
Inherent in their design, Accountable Care Organizations (ACOs) are responsible for the total care of their assigned patient population. Their savings are based on the overall quality, quantity, and cost of care their beneficiaries receive. This alone is no easy feat. Yet, for those ACOs participating in Centers for Medicare and Medicaid Services (CMS) programs,…
Across late August 2024, the Centers for Medicare & Medicaid Services (CMS) recently finalized the Transforming Episode Accountability Model (TEAM) in the Hospital Inpatient Prospective Payment System Final Rule. This is CMS’ latest attempt to transition all traditional Medicare beneficiaries into an accountable care relationship by 2030. Specialty care strategies are an important piece of…
In its first three years of operation, Medicaid’s primary care-focused Accountable Care Organizations (ACOs) in Massachusetts showed “no clear evidence of success” in improving asthma care for children, according to research led by the University of Massachusetts Amherst and UMass Chan Medical School-Baystate Health. The study, published recently in JAMA Pediatrics, compared the asthma care…
This week, I had the honor of delivering the opening plenary at the NAACOS 2024 fall conference in Washington, D.C., where over 1,000 leaders from across the country gathered to discuss the future of accountable care organizations (ACOs) and value-based care. As always, the event served as an exceptional educational forum, bringing together clinical leaders,…
At an Institute for Value-Based Medicine® event held in Park City, Utah, in partnership with Intermountain Health, Miriam Godwin, CMMI, National Kidney Foundation, spoke to the role public policy and value-based care play in regard to kidney health. In this interview, she explores more in depth the key issue that comes with balancing immediate cost…
CareNu is starting to sign members up for health insurance through its Medicare Advantage plan for the first time. The plan, offered through CareNu subsidiary SECUR Health Plan, is an Institutional Special Needs Plan, or I-SNP. It targets the highest acuity patients that account for the bulk of a health plan’s costs. “We created this…
Last year, researchers looked at the directories of the nation’s five largest health plans and found that four out of five entries were inaccurate. This is more than a minor inconvenience. It’s a financial blackhole for all stakeholders and a disruption, if not a complete obstruction, to patient care. Over 50% of all patients use…
According to the Centers for Medicare & Medicaid Services (CMS), value-based care focuses on the quality and performance of a health care providers’ medical services, making the patient’s experience the forefront of how they receive care. Recently seen as an alternative to fee-for-service clinical care—which requires patients or their insurance plans to pay for each…
The fee-for-service (FFS) payment model that has been the norm in healthcare for decades may finally be on its way out, with many physicians and hospital leaders leaning into value-based care (VBC). However, the path to a VBC future remains challenging, particularly as organizations must face one of the biggest hurdles: data sharing and interoperability….