Federally qualified health centers (FQHCs) provide comprehensive primary care and preventive services to more than 31.5 million patients across the United States, regardless of their ability to pay. FQHCs have a unique financing structure that relies on federal grant funding and low Medicaid reimbursements. As a result, they operate on thin, often unpredictable financial margins,…
Chronic Wounds: A Look at the human and financial toll Over the past few years, in an effort to promote better outcomes for patients, healthcare providers, payers, researchers, and regulators have started paying more attention to a once-overlooked area of healthcare: chronic wounds. Chronic wounds encompass injuries such as burns and surgical site infections, as…
Download Slides Receiving recommended breast cancer screenings (BCS) helps detect cancer early, when it is most treatable. Barriers to BCS completions are most prevalent among people of color, with black women having a 41% higher mortality rate from breast cancer compared to white women. Institutionalized racism, lack of access, and misinformation are among the…
Download Slides The Centers for Medicare and Medicaid Services (CMS) is displaying a strong commitment to transitioning the healthcare system towards 100% value-based care (VBC) by 2030. This ambitious goal signifies a significant shift from the traditional fee-for-service model to value-based payment models. The move towards VBC is driven by the increasing recognition of…
Black Book Research has revealed the leading consultants for physician practices and medical organizations, based on feedback from 1,707 VBC providers regarding advisory outcomes, and client satisfaction. A total of 56 consultant firms received crowd-sourced evaluations from polls conducted between September 2023 and February 2024. For the seventh consecutive year, CareAllies, a division of The…
Accountable care organizations are calling on the feds to increase participation of long-term and post-acute care providers in ACOs and to better incorporate episodic-based payments. The recently released white paper highlights ways the ACO REACH Model and Medicare Shared Savings Program (MSSP) can be utilized to grow participation. “If CMS is to achieve its goal…
The nursing home sector’s minimal participation in Accountable Care Organizations (ACOs) – largely because they have not found it lucrative to be in ACOs or have been sidelined within ACOs by other provider types – has resulted in a push for change. In a joint effort aimed at enhancing the integration of long-term and post-acute…
Fee-for-service reimbursement models have contributed to a fragmented behavioral health industry. Substance use disorder (SUD) providers are set to evolve current reimbursement models to alternative payment systems in 2024. Alternative payment models, which include risk-bearing, bundled payments and shared savings, offer a brighter future for the industry. But taking on risk and working with payers…
There has been recent policy interest in improving the affordability and access of prescription medications, including efforts to reduce disparities in access for low-income and minority beneficiaries. For example, the Inflation Reduction Act (IRA) is being implemented in response to continued concerns about drugs affordability, with a focus on reducing the price of selected drugs…
Download Slides Cost control has been hard to achieve in Value-Based Care, regardless of payment models. With lowering total cost of care (TCOC) a key Quadruple AIM goal, APP Quality Reporting opens new avenues to ACOs to amplify their opportunities to examine patient costs and create targeted interventions. In this area we’ll highlight five…