On Jan. 1, 2025, the U.S. Center for Medicare & Medicaid Services’ (CMS) Innovation Center will begin implementing a payment model for primary care known as the Accountable Care Organizations (ACOs) Primary Care Flex Model under the Medicare Shared Savings Program (MSSP). The ACO Flex Model is a voluntary initiative to improve funding and other…
Providers, health systems, and health plans across the country continue to be engaged in conversations about value-based care – and often the focus remains on the burdens and challenges of making the shift. Across the industry, we hear about the difficulties of transitioning from fee-for-service to value-based care, and those concerns are valid. However, we…
The Department of Health and Human Services (HHS) is locking in its enforcement strategy to keep healthcare providers from blocking access to electronic health information. On Monday morning the department released its final rule (PDF) outlining disincentives for eligible hospitals or critical access hospitals, clinician groups and accountable care organizations (ACOs) found to have committed…
The President and CEO of Intermountain Health describes why and how the organization is expanding its value-based care offerings, including the payment mechanism itself and connecting the care journey; the drive to simplify care and expand access for patients, caregivers, and health plan members; and recent partnerships developed that extend the health system’s reach and…
The healthcare industry is slowly moving away from a fee-for-service model to a value-based care model. But one thing that is missing in the discussions around value-based care is how it is being measured, according to Don Antonucci, president and CEO of Providence Health Plan. “Some people say value-based care and they’re talking about affordability…
Medicare, Medicaid and private insurance are increasingly encouraging health care practices to participate in value-based care models such as Managed Care Organizations, Accountable Care Organizations and Medicare Advantage. The industry’s perspective is that paying some providers prospectively based on outcomes – rather than retrospectively based on each service provided – tends to better support patient…
Last month, the CDC reported that 90 percent of our annual $4.5 trillion in healthcare spending is devoted to people with chronic and mental health conditions. And we know that 70 percent of Medicare beneficiaries, for example, suffer from two or more chronic conditions. These are staggering numbers we can’t turn away from, and a…
In the healthcare world, everyone wants to achieve better outcomes at lower costs. But this is much easier said than done, pointed out Dr. Patrick Runnels, chief medical officer at Cleveland-based University Hospitals. “We’ve been pursuing better outcomes at a lower cost without changing the fee-for-service expectations, which means we’re adding a bunch of stuff…
The annual AHIP (America’s Health Insurance Plans) conference is always a cornerstone event in the healthcare industry, bringing together leaders, innovators, and policy makers. This year’s AHIP 2024 was no exception, offering a wealth of knowledge and insights. Here are the top five takeaways that will shape the future of healthcare. 1. Emphasis on Value-Based…
Healthcare call centers are embracing artificial intelligence (AI) and automation as tools for both improving the patient/plan member experience and streamlining processes to increase efficiency and reduce costs. Provider and payer organizations can greatly benefit from delivering a superior customer experience; if they can do so while cutting costs, that’s even better. But AI and…