Experts believe value-based care won’t ever reach scale unless fundamental barriers are addressed — including voluntary models, misaligned payer incentives, excessive metrics and weak employer engagement. The way healthcare is paid for is one of the most powerful levers shaping the future of the industry. Reimbursement structures determine which treatments are offered, how clinicians spend…
On Tuesday afternoon at the MGMA Leaders Conference 2025 in Orlando, Florida, an expert panel, moderated by Shane Jackson, MBA, president of Jackson Healthcare, wrestled with deceptively simple question: Is medicine still a calling? The question was first posed in a joint report published by the two organizations earlier this year. The panel was comprised of Tony Stajduhar, president…
In 2023, direct spending within orthopedics, oncology, cardiology, women’s health, behavioral health and nephrology made up 38% of all total medical spending, and 68% of total commercial and Medicare spending, according to a July 22 report from consulting firm McKinsey & Co. Here is how Medicare and commercial spending changed from 2020 to 2023, by specialty: Full…
Companies operating under the payvider business model, such as VNS Health and Humana Inc. (NYSE: HUM), have pointed to the ability to provide a more integrated care experience, as well as an increased engagement with value-based care, as a key differentiator. For Humana, the clearest example of leveraging its integrated care to engage in value-based care…
Download Slides As medical practices, we are dedicated to the health and wellness of the panels we serve. We set goals, implement actions, and assess outcomes to best meet patients’ needs. But what about our care team’s outcomes and needs? Now more than ever, with the challenges of employee retention, financial stressors, competing priorities,…
For years, value-based care has remained a central debate in the health care industry amid the ongoing push to improve outcomes while controlling costs. Traditional fee-for-service models have revealed their limitations, such as data fragmentation, misaligned incentives, regulatory complexity, technology gaps, and an overall cultural hesitancy to adopt to a new business practice. These challenges…
Rewards tied to improved hospital readmission rates were so small and so variable from year to year that they likely contributed to a “lack of effectiveness” for a key nursing home financial incentive program. The Skilled Nursing Facility Value-Based Purchasing program is the Centers for Medicare & Medicaid Services’ largest use of financial incentives to…
This report provides a definitive analysis for venture capital (VC) investment in the value-based care (VBC) healthtech sector. While VBC represents a profound and necessary paradigm shift with a multi-trillion-dollar market opportunity, it is not an environment for unsophisticated capital. The core finding is a qualified “yes”: venture capital should strategically back VBC healthtech, but…
Download Slides The TEAM payment model is a CMS program that holds acute care hospitals accountable for surgical care and costs in five different types of surgery accounting for the highest costs in Medicare: CABG, Lower Extremity Joint Replacements, Femur Hip Fracture Repair, Spinal Fusion, and Major Bowel surgery. Central to the payment model…
It takes a village. Moving toward value-based care (VBC) in the U.S. healthcare system requires engagement and cooperation from multiple players. Stakeholders include accountable care organizations, social service and community-based organizations, multiple payers, and a range of providers. Ideally, these groups and individuals work seamlessly together to create multiple policies and payment strategies inherent to VBC…