Payers and providers have long had ups and downs in their relationships, even before the Affordable Care Act. But prior authorization and data interoperability demands, coupled with patient volume and clinical documentation needs, mean payers and providers feel under more pressure than ever before. Value-based care (VBC) offers a care model alternative to the traditional…
After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP….
What You Should Know: – A new report from Sage Growth Partners reveals a striking disconnect in the healthcare industry: while only 20% of C-suite leaders believe progress has been made in value-based care (VBC) recently, 77% plan to increase their participation in these models over the next two years. – The “plot twist” indicates that despite operational hurdles…
Key Takeaways: Unmet basic needs such as social determinants of health (SDOH) impede medication adherence, chronic disease control, and appointment attendance, lowering performance on blood pressure control, diabetes A1c, kidney health evaluation, hypertension management, medication adherence (triple weighted), and all-plan readmissions measures. Interventions such as medically tailored meals, food delivery, transportation support, and closed-loop referrals stabilize…
Emergency departments (EDs) are under more pressure than ever. Apart from the growing patient volumes, staffing shortages, and increasing expectations to deliver safe, high-quality care, EDs are also a frequent destination for some of the most vulnerable patients, those transferred from skilled nursing facilities (SNFs) and other post-acute facilities. Too often, SNF patients arrive with…
Download Slides Join us to learn how to harness AI for value-based outcomes—without falling into dangerous traps! As AI rapidly enters healthcare, value-based care (VBC) organizations face unique risks when adopting these technologies. This webinar highlights the most common AI pitfalls—including privacy violations, inaccurate outputs, biased or incomplete data, workflow disruption, and low clinician…
ABSTRACT Value-based payment (VBP) models are increasingly adopted in oncology to promote high-quality, cost-effective, and patient-centered care. To identify essential characteristics of effective oncology VBP models, a modified Delphi process was conducted with 9 experts representing diverse oncology organizations. Panelists participated in 2 survey rounds and an in-person discussion, evaluating the importance and feasibility of key…
Good data is the lifeblood of good healthcare. Ensuring the right information is available to the right care team members at the right time is essential to delivering high-quality care. Two recent trends in healthcare are underscoring this fact. The first, unavoidably, is artificial intelligence. It is critical to have clean and well-governed to make…
Download Slides Regional efficiency is the most influential factor in determining an MSSP ACO’s initial shared savings, yet most ACOs operate without understanding the providers that drive this efficiency. While CMS provides comparative data on membership, key benchmark variables like historical expenditures, risk scores and regional efficiency are only revealed once the performance year…
The ACCESS Model is designed to expand tech-enabled care for Medicare beneficiaries with certain chronic conditions, aligning payments with outcomes for better patient health. What’s the impact? A Medicare model targeting conditions like hypertension, diabetes, chronic pain, and depression with scalable, tech-supported solutions. Providers, tech firms, and health systems gain new reimbursement pathways; applications open…