Following July 1, 2022, most group health plans and issuers of group or individual health insurance across the country are required to disclose pricing information of negotiated rates for healthcare services between insurer and provider under the new Federal Price Transparency Rule (The Rule). The stated purpose of The Rule is “empowering consumers with the…
Following July 1, 2022, most group health plans and issuers of group or individual health insurance across the country are required to disclose pricing information of negotiated rates for healthcare services between insurer and provider under the new Federal Price Transparency Rule (The Rule). The stated purpose of The Rule is to “empowering consumers with the necessary…
The Centers for Medicare and Medicaid Services is releasing data on the Acute Hospital Care at Home initiative through the Research and Data Assistance Center. ResDAC collected data from November 27, 2020, through March 30, 2023. As required for participation, hospitals agreed to report to CMS either weekly or monthly. The Acute Hospital Care at…
Researchers from Mass General Brigham, reporting in npj Digital Medicine, detail their development of a generative artificial intelligence (AI) that can identify social determinants of health (SDoH) from a doctor’s notes. The new model, developed using a large language model (LLM), the finely tuned tool identified 93.8% of patients with an adverse SDoH. This compares…
As 2024 unfolds, the healthcare industry is on the cusp of transformative changes. Propelled by technological innovations and the changing needs of patients, there’s a noticeable pivot towards care centered on the patient, focusing on outcomes. This shift heralds a significant overhaul, spotlighting models that are innovative, efficient and tailored to patient needs. Deloitte’s recent…
The health care industry is again grappling with how aggressively to push providers into payment arrangements that hold them financially accountable for delivering better and more efficient care after the debate was largely put on hold during the pandemic. The big picture: A central question surrounding the long-running movement toward value-based care has been how…
INTRODUCTION The Cleveland Clinic was founded in 1921 as a multi-specialty group practice staffed and run by four physicians who had served in a military hospital in France during World War I. The four men—Drs. Crile, Lower, Bunts, and Philips—were inspired by a vision of a healthcare system in which physicians “acted as a unit,”…
In 2023, OptumHealth saw 900,000 more patients under value-based care, according to a Jan. 12 call with investors transcribed by Seeking Alpha. “Value-based care for us is a proven way of overcoming many of the widely recognized shortcomings of a fee-for-service-based health system such as fragmented consumer experiences and incentives, that can emphasize volume over…
Michael Palantoni says he is seeing growing support for shifting to value-based care, including discussions and cooperation that would have been unthinkable a few years ago. Palantoni is the vice president for platform and data services at athenahealth, the electronic health record company, which is working with payers and providers on addressing gaps in care…
Today’s payers are still adjusting to the significant operational and transparency changes as a result of the No Surprises Act and Consolidated Appropriations Act. These mandates put the provider network operation on the front line and at the eye of the storm of some pressing market conditions—from the regulations to escalating, costly labor challenges and…