Traditionally, healthcare in the U.S. has been based on a fee-for-service reimbursement model, where providers are paid for each service delivered to patients. The problem with this model is that pay is tied to volume, not outcomes— in fact, providers are incentivized to perform extra testing and procedures, emphasizing treatment at the expense of prevention…
When older adults consider enrolling in a Medicare Advantage (MA) health plan they may consider the plan’s Star Rating as a factor. Medicare’s Star Ratings program is designed to help older adults compare MA plans based on quality and performance. It is a scale from 1-5, with five being the highest, that considers quality and patient…
Primary care physician burnout got worse in developed nations around the world during the COVID-19 pandemic. The Commonwealth Fund published “Stressed Out and Burned Out: The Global Primary Care Crisis,” a survey of 9,526 physicians in the United States, Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom, from February…
It is no secret that health systems and hospitals have had a rough 2022 thus far. The pandemic led to increased operating expenses, and though COVID cases have steeply declined, the return of elective/non-urgent inpatient care has yet to fully recover. Health system leaders are working hard to flip the script and ensure patients are…
Download Slides Real social influencers are not found on YouTube® channels or Facebook® feeds. Instead, they are found in communities struggling with food insecurity, housing instability and homelessness, high rates of crime, social isolation, and lack of the most basic healthcare services. Since 2016, HealthEC® and the Prince George’s Healthcare Alliance© in Maryland have…
With the release of the 2023 Physician Fee Schedule Final Rule, CMS upheld its commitment to sunset its Web Interface for ACO quality reporting after 2024. Beginning in 2025, ACOs will be required to report through the Alternate Payment Model Performance Pathway, or APP. Some have expressed concerns about the APP. But this new reporting…
Despite its challenges, value-based care has shown great promise in improving health outcomes and access to care, particularly among traditionally underserved or high-risk patient populations. That was the view of participants in the panel discission, “The Risky Business of Value-Based Care” at the 2022 HLTH conference in Las Vegas. Panel moderator Sara Pinto, a partner…
The Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) payment model will launch on Jan. 1, 2023, and hospices that collaborate with participating ACOs could realize some unique benefits. The Center for Medicare & Medicaid Innovation announced the program in February to replace the Global and Professional Direct Contracting (GPDC) models. The…
The Centers for Medicare and Medicaid Services is looking to improve its data in ways that contribute to a fairer healthcare system, including continuing the development of equity scores and refining the Health Equity Summary Score, as well as addressing bias in various tools and methods. The CMS Framework for Health Equity outlines this approach,…
Affordable Care Act (ACA) marketplace officials are hoping to get more plans into value-based care arrangements as regulators hope to not just build on getting people covered, according to federal officials. Officials with the Centers for Medicare & Medicaid Services (CMS) spoke Thursday at the Health Care Payment Learning and Action Network Summit on value-based…