One focus of the HL7 Da Vinci Project FHIR accelerator has been member attribution lists used by payers and providers for implementing value-based contracts, care gap closures and quality reporting. MultiCare Connected Care (MCC), an accountable care organization in Washington State, recently deployed a FHIR-based application programming interface (API) to help solve the attribution issue….
In 2021, the Centers for Medicare & Medicaid Services (CMS) established a goal to have 100 percent of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030 as part of the Center for Medicare and Medicaid Innovation’s (Innovation Center) strategic refresh. This means that beneficiaries should experience longitudinal,…
Since the emergence of the COVID-19 pandemic, many healthcare leaders and experts have said the pandemic has vividly illustrated the inequities in health treatment and outcomes among disadvantaged groups. Eboné Carrington, managing director of Manatt Health, said those disparities in healthcare among minority groups and those with lower incomes haven’t exactly been hidden. The fact…
A strong business case exists for addressing the financial impacts of social determinants of health (SDoH) and new reimbursement models designed to emphasize health equity. Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy. This is because health disparities contribute more than $93 billion in unnecessary medical care costs and more than $42 billion annually…
Amid an uncertain economy, providers, payers, and patients alike will be turning their attention to value-based care models to cut costs and improve health outcomes. These models, where reimbursement is rewarded based on quality of care, have taken center stage once again in the healthcare discussion. During the pandemic, the industry saw a rapid move…
Jails can provide opportunities to diagnose and treat individuals for HIV. However, supporting care coordination for formerly incarcerated individuals upon reentry into the community can be difficult due to data sharing challenges. Current CDC guidelines for HIV care post-release recommend providing individuals with a 30-day supply of their HIV medication and an appointment with a…
Traditionally, healthcare in the U.S. has been based on a fee-for-service reimbursement model, where providers are paid for each service delivered to patients. The problem with this model is that pay is tied to volume, not outcomes— in fact, providers are incentivized to perform extra testing and procedures, emphasizing treatment at the expense of prevention…
When older adults consider enrolling in a Medicare Advantage (MA) health plan they may consider the plan’s Star Rating as a factor. Medicare’s Star Ratings program is designed to help older adults compare MA plans based on quality and performance. It is a scale from 1-5, with five being the highest, that considers quality and patient…
Primary care physician burnout got worse in developed nations around the world during the COVID-19 pandemic. The Commonwealth Fund published “Stressed Out and Burned Out: The Global Primary Care Crisis,” a survey of 9,526 physicians in the United States, Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom, from February…
It is no secret that health systems and hospitals have had a rough 2022 thus far. The pandemic led to increased operating expenses, and though COVID cases have steeply declined, the return of elective/non-urgent inpatient care has yet to fully recover. Health system leaders are working hard to flip the script and ensure patients are…