Value-based care (VBC) is not new. The concept began in the 1980s with the introduction of managed care and capitation models, where providers were paid a set amount per patient rather than per service. However, it gained significant traction in the early 2000s and continues to evolve with ongoing efforts to refine payment models, improve…
Achieving the Centers for Medicare and Medicaid Services’ (CMS’s) goal to bring every Medicare patient into a value-based care (VBC) arrangement by 2030 requires bold action. With six years left to achieve that goal (as of January 2024), only half of current Medicare beneficiaries are aligned with an accountable care organization (ACO) providing care within…
As the post-acute care industry continues transitioning towards a value-based care system, skilled nursing facilities (SNFs) should start to consider participating in an Accountable Care Organization (ACO) to not only help in achieving optimal outcomes but improving patient care journeys uniformly. Building a clinically robust continuum of care includes long-term acute and post-acute care hospitals…
The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a new avenue of funding for Accountable Care Organizations (ACOs) with implications for palliative care providers. The agency’s 2025 Physician Fee Schedule proposed rule contains a provision that would establish a new “prepaid shared savings” option for Medicare Shared Savings Program (MSSP) participants. This…
The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. The National Association of ACOs (NAACOS) said it is still digesting the changes and listening to members’ initial thoughts. “I think it’s a bit mixed,” Aisha Pittman, senior vice president…
The Department of Health and Human Services (HHS) regularly refines its policies and operational guidelines in an ongoing effort to better serve patients and support sustainable value-based care delivery. To that end, HHS and CMS recently announced three important updates: Revisions to HHS risk adjustment model algorithm software Changes to cost-sharing reductions (CSRs) Deployment of…
In creating your strategies for cost control, your ACO must consider how to reduce Total Per Capita Cost (TPCC) while ensuring the financial survival of your ACO and participating providers. This balancing act is the dilemma facing all providers adopting Value-Based Care: how to achieve more savings while replacing revenue lost from services. Here’s how…
The Impact of Meaningful Patient-Provider Relationships In the evolving landscape of healthcare, the dynamic between patient and provider is increasingly scrutinized. As technology continues to integrate into everyday healthcare practices, it’s essential to assess whether these tools foster meaningful relationships or if they inadvertently encourage a more transactional approach. Drawing from Adam Grant’s insights on…
Value-based behavioral health involves measuring an organization’s impact on a patient’s health. How impact is defined and translated into value varies depending on several factors. At the broadest level, the various levels of care acuity require different approaches. They may also have advantages and disadvantages when it comes to value-based care in the first place….
The release on July 10 of the proposed Calendar Year 2025 Medicare Physician Fee Schedule from the Centers for Medicare & Medicaid Services (CMS) prompted discussions among healthcare industry professionals. On July 16, the Washington, D.C.-based Primary Care Collaborative (PCC) hosted an online discussion with CMS leaders about how Medicare Part B payment policy could…