CareFirst BlueCross BlueShield and Children’s National Hospital in Washington, D.C., have entered into a value-based care alliance to address three key priority health conditions: behavioral and mental health, diabetes, and infant mortality. The first initiative involves addressing the youth mental health crisis. As part of this alliance, nonprofit CareFirst has increased the reimbursement for preventive…
Established healthcare organizations, whether it be health systems, accountable care organizations, or independent provider groups often grapple with the dilemma of fully embracing risk. Fears of taking downside risk and capitation payments are intimidating given the known unknowns regarding participating in fully risk-based programs, regardless of whether one operates within the Medicare Shared Savings Program…
Everywhere you look today, artificial intelligence (AI) is making an appearance and offering to do something you already do smarter, faster or just a little more efficiently. Or it’s allowing new, exciting ways to look at old problems. Across health care, it’s opening up new opportunities to weigh risks and improve diagnoses, personalize medicine and…
Kaiser Permanente announced a significant AI partnership this week aimed at enhancing value-based care. The West Coast-based health system is deploying Innovaccer’s healthcare AI platform and population health management tools — starting with its Washington market and potentially expanding to new markets in the future. This initial deployment, which will serve about 650,000 Washington patients,…
On March 19, 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model—the Accountable Care Organization (ACO) Primary Care Flex Model (ACO PC Flex Model)—which will test primary care capitation in CMS’s permanent ACO program, the Medicare Shared Savings Program (MSSP). Under the model, monthly prospective primary care payments to MSSP ACOs will…
Navigating the Shift: Transitioning from CMS Web Interface to APP As the 2024 performance year ends, MSSP ACOs (Medicare Shared Savings Program Accountable Care Organizations) are bracing for new reporting obligations under the Quality Payment Program (QPP). The Centers for Medicare and Medicaid Services (CMS) is gearing up for a complete transition to digital quality…
A coalition of 11 groups representing accountable care organizations (ACOs) and other health care stakeholders wants the government not to consider “anomalous” Medicare spending that is outside ACOs’ members control when determining if an ACO has exceeded its annual spending benchmarks In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid…
Download Slides Explore the impact of V28 on revenue, uncover key diagnoses, and learn mitigation strategies. With V28 in full swing, it’s a great time to review the experience of our first year. We’ve been digging into the data to understand what it’s telling us about strategies that are successful and unsuccessful in managing…
Valued-based care has become a household name in healthcare. Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker’s to answer, “What is the future like for value-based care in orthopedics?” Note: This response has been lightly edited for length and clarity. Dr. Philip Louie: Very complicated, like…
Download Slides Dr. Sheila M. Magoon, Family Practice provider and clinical expert, will share how her system navigates complexities of rising costs and utilization of their aging patient population. Their strategy consists of pinpointing specific sub-populations based on predicted future risks of utilization, complication, and developing chronic diseases and deploying tailored interventions that reduce…