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….
Download Slides Accurate coding is extremely important in the era of value-based care. If coding is inaccurate, it can result in significant financial penalties, damage to reputation, and missed opportunities to maximize reimbursements. Additionally, adherence to key compliance requirements and good clinical documentation practices are essential to avoid legal and financial repercussions. Key Takeaways:…
The Institute for Value-Based Medicine event hosted by The American Journal of Managed Care (AJMC) in Nashville, Tennessee, on August 22, 2024, spotlighted various perspectives on specialty value-based care and explored how innovation and entrepreneurship can help adapt to the evolving health care landscape.1 Presented by AJMC and Tennessee Oncology, the event featured Katherine Baker,…
Specialty care makes up a significant portion of healthcare spending, yet accountable care organizations (ACOs) often lack a specialty care strategy to lower costs and optimize specialty care. This disconnect arises due to distinct payment models that pay specialists separately, alongside care management systems that don’t attempt to integrate ACO primary care physicians and specialists….
Let’s face it—healthcare is changing, and fast. The old fee-for-service model, where providers were rewarded for cranking out more tests and treatments, is fading into the background. Enter value-based care, a model that prioritizes patient outcomes over the number of services performed. And at the heart of this transformation? One thing: quality. But quality isn’t…
On July 1, 2024, the CMS Innovation Center launched the Guiding an Improved Dementia Experience (GUIDE) Model, with 390 participating organizations building dementia care programs that will serve hundreds of thousands of people with Medicare nationwide. One of the GUIDE participants is a Seattle-based startup called Rippl, which recently raised $23 million in Series A…
While progress toward the adoption of value-based care has been a slow lumber, the healthcare industry is still pushing toward that transition, with UnitedHealth Group weighing in on how best to accelerate that transformation. In its latest “A Path Forward” report, UHG said that as of 2023, about 60% of UnitedHealthcare members are served by…
With pressure building on Congress to solidify telehealth payment flexibilities set to expire at the end of the year, we must ensure legislators weigh the ability of virtual health care services to promote health equity. Telehealth services can help advance the goal of ensuring all people have equal opportunity to reach their full health potential,…