A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were. The civil suit alleges that Aledade Inc.’s billing apps and other software and guidance…
Systemic racial biases persistently shape the health care experiences of Black, Latinx and Indigenous populations. These biases are especially pronounced for women of color, influencing everything from diagnosis and family planning to treatment recommendations. In fact, Centers for Disease Control and Prevention data show that Black women are two to three times more likely to…
The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. In 2023, VBC grew and evolved as healthcare providers, payers and policymakers sought to improve patient results while containing costs. Expect to see more of the same investments and trends in VBC…
Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That is a…
In the supermarket, we look for fish that’s sustainably raised. We’re swayed by sustainable practices from hotels and retailers. So why wouldn’t the same standard apply to the most important service industry in the world, healthcare? The fact is that the traditional fee-for-service model, charging patients and plans for every blood draw, X-ray, and surgery,…
Since the implementation of the Affordable Care Act, a major shift has been underway in how individuals in traditional Medicare receive their services. The Centers for Medicare and Medicaid Services (CMS) has been systematically developing programs that focus on providing value-based care (VBC) to these enrollees. These programs include the Medicare Shared Savings Program (MSSP);…
Download Slides If you want your VBC organization to thrive in 2024, you need to educate yourself and your providers on the CMS-HCC V28 changes. Join us for a webinar where Credo Founder and CEO Carm Huntress will help you do just that! Carm will share his top takeaways from the first month of…
Insurtech Alignment Healthcare has recorded $1.82 billion in revenue for full-year 2023 and beat market expectations for quarterly revenue by more than $20 million, the company announced Feb. 27 during its 2024 fourth-quarter earnings call. However, its earnings per share was a loss of 25 cents, falling short of Wall Street expectations of a loss of…
In order to be successful moving forward, home-based care providers will need to understand the value-based care landscape and be prepared to operate in this space. That’s one key takeaway from a new report released by Transcend Strategy Group, an at-home care-focused growth strategy firm. The report is an overview of value-based care’s history, as…
Optum Health CEO Amar Desai, M.D., took the stage at ViVE on Monday morning to discuss the company’s value-based care ambitions and strategy, but there was a clear elephant in the room: the cyberattack on Change Healthcare that’s still causing disruption nationwide. Desai said the Optum team has been in regular communication with its clients’…