The introduction of the phrase “value-based care” into the industry lexicon can be tracked back to 2010 driven by the reforms of the Affordable Care Act (ACA). The HMOs of the 1990s weren’t balanced with quality, access, consumerism, nor were they tech enabled. They indeed failed spectacularly but moving back to FFS indefinitely wasn’t the…
Healthcare is undergoing a transformation and value-based care is taking center stage. American physicians are increasingly participating, with 54% of them reporting being in at least one accountable care organization. This figure jumped 10% from 2018 to 2020, according to the American Medical Association during their Physician Practice Benchmark Survey. Although participation is increasing, common…
Innovation in healthcare is accelerating. Seismic changes include adoption of virtual health modalities spurred by the COVID-19 pandemic, disruption in the payer sector by tech-based upstarts, and the expansion of care settings outside the hospital. In this environment, in October 2021 the Center for Medicare & Medicaid Innovation (CMMI) published its innovation strategy for the…
With the health care industry continuing to evolve toward a value-based care model, data interoperability has become more crucial. In this interview with Integrated Healthcare Executive, Mark Braunstein, MD, professor of the practice emeritus at Georgia Tech and board of directors’ member at Rimdi, Inc, describes how substitutable medical applications and reusable technologies (SMART) on…
As our country continues to reflect on the devastating impact of Covid-19 and the World Health Organization noted that the ‘end is in sight’ for the pandemic, we need to recognize and address the disproportionate hardships that Black and Latino communities have faced over the last two plus years. Latino communities, who experienced some of…
Just over half of Medicaid managed-care plans have health equity strategies for specific populations of members, and around 4 in 10 have health equity plans for all of their members, a survey from the Institute for Medicaid Innovation found. The institute’s fifth annual “Medicaid Health Plan Survey” includes data from almost every state with managed…
It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill…
The Biden administration wants primary care and specialty providers to work closer together, including via new population-based payment models to bolster referrals to specialists. The Center for Medicare and Medicaid Innovation (CMMI) released a report Monday updating its strategic vision for implementing value-based care, including detailing its progress since the vision was released last year….
Many providers hesitate to embark on the transformation into accountable care organizations (ACOs) for two major reasons: anxiety about downside risk-based payments models and the challenge of balancing fiscal performance with the mission of delivering high-quality care. To successfully transition into an ACO, providers must constantly refine workflows, processes, and performance indicators. To this end,…
One of the most consequential shifts I’ve seen during 20 years in the biopharmaceutical industry is happening right now: A combined focus on patient-centricity and health equity is changing how companies approach end-to-end drug development and how we reach patients who’ve historically been left behind. As the child of immigrant parents, who has lived in…