The US health care industry continues a predominant fee-for-service provider reimbursement model, despite trying to shift to a value-based care model for now approaching two decades. Moreover, providers continue to be consumed in a figurative avalanche of paperwork. It is a challenging system for both practitioners and patients, often delivering unpleasant experiences for both. Ultimately,…
Last week, leaders across the health insurance industry descended on Sin City to dig deep into the biggest topics facing payers. From the cost of GLP-1s to value-based care, here are a few key takeaways from the conference: Full Article
Download Slides Join Lightbeam industry advisors, Melissa Tyler and Jennifer Newell as they identify population health pitfalls that are holding back many healthcare organizations’ value-based care performance. Amidst resource constraints and increasing risk exposure, discover how population health leaders can make data-driven program decisions to avoid common pitfalls and manage total cost of care….
At a June 13 congressional hearing, Elizabeth Fowler, Ph.D., J.D., director of the Center for Medicare and Medicaid Innovation (CMMI), was pressed to explain why so few of CMMI’s alternative payment models have produced cost savings. In a meeting of the Health Subcommittee of the the U.S. House Energy and Commerce Committee, Cathy McMorris Rodgers…
Amid rising concerns about health care spending and voters’ worries about health care affordability, there is growing, bipartisan interest in proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site neutral” payments. The goal of this approach would be for Medicare to pay the same rate for the same service,…
What You Should Know: – Health insurance provider Humana Inc. announced the release of a groundbreaking Value-Based Care (VBC) Issue Brief focused on nephrology, the medical specialty treating kidney disease. – The issue brief report highlights the significant potential of VBC arrangements to improve patient outcomes and reduce healthcare costs for individuals with chronic kidney…
As the healthcare landscape continues to evolve, so do the challenges and opportunities presented by CMS’ Quality Payment Program (QPP). Since its inception in 2017, QPP has become increasingly complex, making it harder for providers to avoid penalties and maximize their scores. In the 2024 Performance Year (PY), providers have 199 quality measures available for…
With the current administration of President Joe Biden, the U.S. Centers for Medicare & Medicaid Services (CMS) continue to make health equity a key aspect of value-based care. Studies are increasingly detailing how the conditions in which people are born, grow, live, work, and age – what are known as the social determinants of health…
The American healthcare system is shifting away from traditional fee-for-service (FFS) to a new payment model, one that ties provider reimbursement to patient results rather than the quantity of services provided. This model, value-based care, is gaining traction in the U.S. According to the Health Care Payment Learning & Action Network’s 2023 report on participation…
During the CMS Health Equity conference, the “Implementing Health Equity Through Value-Based Care for People in Medicare” session featured a series of expert speakers who detailed cutting-edge developments in postacute care and fee-for-service Medicare. They shared their insights on pioneering strategies and new codes designed to meet health-related social needs, highlighting practical approaches that propelled…