What You Should Know: – Health insurance provider Humana Inc. announced the release of a groundbreaking Value-Based Care (VBC) Issue Brief focused on nephrology, the medical specialty treating kidney disease. – The issue brief report highlights the significant potential of VBC arrangements to improve patient outcomes and reduce healthcare costs for individuals with chronic kidney…
As the healthcare landscape continues to evolve, so do the challenges and opportunities presented by CMS’ Quality Payment Program (QPP). Since its inception in 2017, QPP has become increasingly complex, making it harder for providers to avoid penalties and maximize their scores. In the 2024 Performance Year (PY), providers have 199 quality measures available for…
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…
The American healthcare system is shifting away from traditional fee-for-service (FFS) to a new payment model, one that ties provider reimbursement to patient results rather than the quantity of services provided. This model, value-based care, is gaining traction in the U.S. According to the Health Care Payment Learning & Action Network’s 2023 report on participation…
During the CMS Health Equity conference, the “Implementing Health Equity Through Value-Based Care for People in Medicare” session featured a series of expert speakers who detailed cutting-edge developments in postacute care and fee-for-service Medicare. They shared their insights on pioneering strategies and new codes designed to meet health-related social needs, highlighting practical approaches that propelled…
The annual government “strategy” to contain the cost of health care by cutting rates misses the cause of the problem: the fee-for-service (FFS) reimbursement model and its disconnect from outcomes that matter. By paying providers based on the number of services they deliver to each patient – tests, examinations, images, etc. – FFS incentivizes providers…
As value-based care becomes commonplace throughout the U.S. healthcare system, physicians and practices are learning how to lean into the trend. Here are seven practices and physicians leaning into value-based care in 2024: 1. Sterling Elliott, PharmD, assistant professor for orthopedic surgery and clinical pharmacist lead at Northwestern Medicine in Chicago, told Becker’s that he…
Download Slides This summer, CMS will launch its eight-year Guiding an Improved Dementia Experience (GUIDE) model where Medicare patients living with dementia and their family caregivers will be able to access comprehensive care and wraparound support services for free. This new payment model supercharges organizations like Remo Health to deliver accessible, affordable, quality dementia &…
For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO…
Catalyst for Payment Reform (CPR), an independent, nonprofit coalition of employers and other healthcare purchasers, and accreditation organization URAC are working to develop an accreditation program for value-based payment programs that will be available in 2025. Most payers have implemented some form of value-based payment for healthcare providers. These models influence payment and care delivery…