Value-based models in Medicare Advantage (MA) achieve better patient outcomes and more efficient care compared to traditional Medicare, according to a recent study from Optum. The study, which was published in JAMA Network Open, included data on more than 316,000 people, split evenly between MA members in a two-sided risk accountable care model and traditional Medicare…
The evidence of the disproportionate impact of the COVID-19 pandemic has galvanized calls for change and a renewed determination by local, state, and national regulatory bodies to make health care more equitable and reduce the long-standing disparities in health outcomes. The disproportionately detrimental effect on the health and well-being of various patient groups is not…
As 2023 dawns, strategic conversations in health care are shifting away from the pandemic’s “crisis mode” to refocus on addressing long-term needs and opportunities to improve patient outcomes. Patient engagement is an area that is consistently discussed as ripe for evolution. In an ideal world, every health care provider would be focused on patient engagement…
For PY 2024, the process ACOs use for making their annual model, track, and participant selections should be modified to include several recently announced regulatory changes. Foremost among them is a new multimillion dollar decision: Whether to early renew to take advantage of the MSSP methodology changes defined in the 2023 Medicare Physician Fee Schedule…
Accountable care organizations have demonstrated success in improving quality of care for patients, including underserved and vulnerable individuals, while saving $13.3 billion in gross savings and $4.7 billion in net savings to Medicare in the past decade. The Centers for Medicare and Medicaid has set a goal of having all beneficiaries in accountable care models…
On February 1, 2023, CMS released the Medicare Advantage (MA) Advance Notice which is a document used to give notice to MA plans about upcoming changes to the model for the following performance year. MA plans are given a period of time in which they may submit comments on the proposed changes. In early April…
Download Slides While the shift from volume to value is underway, a second shift to health equity is beginning. Driven by CMS, many organizations are preparing to address health equity and social determinants of health across the enterprise, many for the very first time. Although ACO REACH and the Enhanced Oncology Model are among…
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…
I typically start a new year feeling more positive about what we can achieve in healthcare, only to reach December feeling that progress hasn’t occurred. Then in January, I look at what the influencers, pundits, and soothsayers have to say about the coming year and think, are we on the same planet? So, let us…
The Biden administration rolled out three new payment models intended to lower drug costs, including new Medicare coverage options for drugs cleared under accelerated approval. The release of the three models on Tuesday is in response to an executive order President Biden delivered last year calling for the federal government to search for ways to…