July brings us baseball, fireworks, and CMS’s Proposed Rules. In 2,248 pages of proposals, CMS has outlined its plans for MIPS, ACOs, and other Advanced Alternate Payment Models, and how they will transition from fee-for-service into a value-based care arrangement through the Quality Payment Program (QPP). We already know from the 2024 Final Rule that…
Download Slides To remain competitive, ACOs, Medical Groups, and Physician Networks must control costs, while simultaneously delivering excellent care. Creating a long-term transformation strategy that harmonizes primary and speciality services into whole-person care that fulfills these objectives can be a daunting task, particularly at the beginning of your value-based care journey. However, there’s no need to…
Download Slides Value-based care (VBC) arrangements between payers and providers continue to grow, fueled by the Center for Medicare and Medicaid’s (CMS’) ambitious goal of achieving 100% accountable care for Medicare beneficiaries by 2030. To be successful under these arrangements, provider organizations need to understand the VBC landscape and the levers they have available…
It’s 2024, and we’re living in a digital world. Yet far too many healthcare providers are making do with outdated and incomplete methods for collecting, analyzing, and using medical records. With the rollout of CMS-HCC V28, the publication of TEFCA 2.0, and the continued push for national interoperability, now is the time for value-based care…
Value-based specialty care can help transform care delivery and improve patient experiences and outcomes, so it’s no surprise that it has been major topic of conversation this year. A common refrain heard at healthcare conferences and in industry media is that value-based specialty care is coming, and healthcare organizations can either get on board or…
Within the health care system, payers and physicians have long operated at odds with one another. While both have a goal to improve patient and member health, their approaches often differ, creating friction. Physicians get frustrated when they have limited information about how data are collected and used to calculate patient attribution and payments. They…
Pediatrics has been at the forefront of preventive medical practices such as immunizations, screenings, care coordination with specialists and meeting defined health goals. Measurable prevention is a major cornerstone of providing value-based care, so it would seem the approach would pair well with pediatrics. But it’s not that simple, because there is a wide range…
Reimbursement issues at nursing homes are pushing operators to adapt their payment models to increase reliance on Institutional Special Needs Plans (I-SNPs) and Accountable Care Organizations (ACOs). But while these models aim to enhance care quality even as they control costs, they also bring on unique challenges, including requiring extra oversight with discharges and related…
Many healthcare delivery organizations have adopted some form of value-based payment model in recent years, shifting the healthcare focus from quantity of services to quality of outcomes. In a promising trend for healthcare overall, more than half of healthcare payments in 2023 were part of a value-based care reimbursement model. Capitation – which provides a set fee per…
The benefits of artificial intelligence (AI) include predictive analytics, personalized treatment plans, operational efficiency, and and remote patient monitoring, says Liz Kwo, MD, MBA, MPH, chief commercial officer, Everly Health; faculty lecturer, Harvard Medical School, and author of the book, DigitalMD. This transcript has been lightly edited. Transcript How can AI effectively contribute to value-based…