Background: The Center for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation tests service delivery models designed to improve care quality and patient outcomes while reducing or maintaining program costs. Historically, Innovation Center models were not explicitly designed to serve underserved populations, and most evaluations have not focused on health equity-related outcomes. In…
Realizing value-based care success is easier said than done. While a primary goal of value-based care is to improve long-term health outcomes and costs, that can be difficult when consumers’ healthcare journeys are disrupted each year. In simple terms, it takes longer than 12 months to meaningfully change health outcomes, placing the notion of annual…
Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time and is the eighth leading cause of death in the US. This widespread condition affects approximately 1 in 7 adults (more than 37 million people) and an estimated 38% of US seniors. Of these affected patients, it has…
A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of…
New legislation is leading some hospices to consider what a potential community-based palliative care payment demo would mean for them — as well as what it would look like. Four U.S. senators recently introduced a bipartisan bill that, if enacted, would steer the Center for Medicare & Medicaid Innovation (CMMI) to develop a palliative care-specific…
The advent of value-based care, based on the Institute for Healthcare Improvement “Triple AIM” framework — improving the health of populations, reducing the per capita cost of care and improving the individual experience of care — has motivated providers to shift their focus from volume to value. And, as providers shift to value-based activities, their…
Since the Affordable Care Act was signed into law in 2010, the Centers for Medicare & Medicaid Services has been encouraging physician practices to move from a fee-for-service payment model to one that rewards value. It has been testing models that incentivize clinicians to provide preventive, proactive and appropriate care that improves patient outcomes and…
Payers and private equity investors are among the new entrants stepping deeper into the hospice space. This trend has heated up competition and merger and acquisition (M&A) activity, while posing opportunities for strategic growth in an evolving value-based landscape. The hospice industry has seen a swath of new entrants amid record-level transaction volume and soaring…
When deployed at scale, palliative care can help achieve many of the health care systems current goals, including reduced costs, improved patient satisfaction and quality of life. Despite this potential, existing programs hit barriers created by misconceptions about palliative care among referring physicians, as well as health equity concerns, among others, according to an analysts…
One of the primary goals for Medicare Advantage (MA) and other value-based care (VBC) programs is to effectively manage patients’ chronic conditions and avoid complications, including hospital admissions and re-admissions, and costly interventions. To accurately compensate providers for the care of these patients, VBC programs rely on clinical risk scores based on the diagnoses for…