Medicare, Medicaid and private insurance are increasingly encouraging health care practices to participate in value-based care models such as Managed Care Organizations, Accountable Care Organizations and Medicare Advantage. The industry’s perspective is that paying some providers prospectively based on outcomes – rather than retrospectively based on each service provided – tends to better support patient…
Last month, the CDC reported that 90 percent of our annual $4.5 trillion in healthcare spending is devoted to people with chronic and mental health conditions. And we know that 70 percent of Medicare beneficiaries, for example, suffer from two or more chronic conditions. These are staggering numbers we can’t turn away from, and a…
In the healthcare world, everyone wants to achieve better outcomes at lower costs. But this is much easier said than done, pointed out Dr. Patrick Runnels, chief medical officer at Cleveland-based University Hospitals. “We’ve been pursuing better outcomes at a lower cost without changing the fee-for-service expectations, which means we’re adding a bunch of stuff…
The annual AHIP (America’s Health Insurance Plans) conference is always a cornerstone event in the healthcare industry, bringing together leaders, innovators, and policy makers. This year’s AHIP 2024 was no exception, offering a wealth of knowledge and insights. Here are the top five takeaways that will shape the future of healthcare. 1. Emphasis on Value-Based…
Healthcare call centers are embracing artificial intelligence (AI) and automation as tools for both improving the patient/plan member experience and streamlining processes to increase efficiency and reduce costs. Provider and payer organizations can greatly benefit from delivering a superior customer experience; if they can do so while cutting costs, that’s even better. But AI and…
The US health care industry continues a predominant fee-for-service provider reimbursement model, despite trying to shift to a value-based care model for now approaching two decades. Moreover, providers continue to be consumed in a figurative avalanche of paperwork. It is a challenging system for both practitioners and patients, often delivering unpleasant experiences for both. Ultimately,…
Last week, leaders across the health insurance industry descended on Sin City to dig deep into the biggest topics facing payers. From the cost of GLP-1s to value-based care, here are a few key takeaways from the conference: Full Article
Download Slides Join Lightbeam industry advisors, Melissa Tyler and Jennifer Newell as they identify population health pitfalls that are holding back many healthcare organizations’ value-based care performance. Amidst resource constraints and increasing risk exposure, discover how population health leaders can make data-driven program decisions to avoid common pitfalls and manage total cost of care….
At a June 13 congressional hearing, Elizabeth Fowler, Ph.D., J.D., director of the Center for Medicare and Medicaid Innovation (CMMI), was pressed to explain why so few of CMMI’s alternative payment models have produced cost savings. In a meeting of the Health Subcommittee of the the U.S. House Energy and Commerce Committee, Cathy McMorris Rodgers…
Amid rising concerns about health care spending and voters’ worries about health care affordability, there is growing, bipartisan interest in proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site neutral” payments. The goal of this approach would be for Medicare to pay the same rate for the same service,…