Download Slides Specialty costs have long been a gnarly issue for ACOs, which currently have no ability to either steer or manage specialty costs. But Change is in the air, and it’s coming through ASM and TEAM, two large-scale specialty care risk payment models. Both payment models require referrals to primary care physicians for…
Health systems are responding to fragmented behavioral healthcare delivery in different ways: expanding telepsychiatry in rural states, building pediatric health hubs that integrate mental and physical health on one campus, launching behavioral health urgent cares, and investing in navigators and data infrastructure to keep patients connected after discharge. In West Virginia, the access challenge is…
The Medicare Advantage (MA) Star Ratings program is undergoing a fundamental shift. Instead of primarily rewarding health plans’ operational compliance and administrative performance, the focus is moving toward measurable clinical outcomes and member experience. As a result, medication management will increasingly influence both Star Ratings performance and financial outcomes, making it a critical area for…
Submitting data to CMS is one of those tasks that sounds straightforward until you realize how many moving parts are involved. A missed measure, an incomplete record, or a data entry mistake can drag down your MIPS score and leave money on the table. The good news is that a solid internal audit can catch…
Physicians told Becker’s that the next major shift in medicine won’t be a new device or breakthrough drug, but the accelerating shift from fee-for-service to value-based purchasing. Cost pressures, patient frustration and employer fatigue are converging in ways that may force a structural reset in how physicians practice and get paid, several said. Steven Rich, MD, a…
Making any additions or changes to your organization requires a lot of very careful planning and observation. While these additions/changes can be a huge benefit, opening up your organization to implement them can also cause a lot of problems. It can introduce new weak points for cybercriminals, it can cause friction with your existing systems,…
Download Slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…
Download slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…
Value-based care represents one of health care’s most important transformations, driving hospitals and health systems to focus on outcomes that truly matter. To succeed in this model, organizations must track and improve their performance metrics continuously, making data health care’s most valuable currency. It is the foundation for improving patient care, reducing complications, and optimizing…
Value-based care continues to account for a substantial share of U.S. healthcare payments, underscoring sustained payer investment in payment models that link reimbursement to quality and cost outcomes. The findings come from a survey released by AHIP in collaboration with the Centers for Medicare and Medicaid Services. Danielle Lloyd, M.P.H., AHIP’s senior vice president of private market…