Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021, the US spent 17.8 percent of gross domestic product on healthcare, nearly twice as much as the average high-income country, a study from the Commonwealth…
The cost of medications continues to rise, spurred in part by the introduction of new and costly drug therapies. These increased costs have caused policymakers, public payers (i.e., Medicare and Medicaid), and commercial health insurers to closely examine the results achieved by such therapies and consider the growing disparities in drug access and outcomes. The Inflation…
Just as smart industries are putting aside their paper-laden processes and embracing exciting technologies, healthcare is ditching many cumbersome manual practices—albeit at a much slower pace. As a healthcare tech CEO, I cannot wait to see our industry catch up to our peers in using artificial intelligence (AI), large language models (LLM), machine learning (ML),…
Download Slides CMS intends to phase “Traditional MIPS” out of the Quality Payment Program in a few short years. To avoid financial penalties, groups will need to demonstrate their value-based care acumen by reporting MIPS Value Pathways (MVPs). Learn how to create and implement an MVP strategy now that will give you an advantage…
The American Heart Association, a global force for longer, healthier lives for all, is advocating for a shift away from the current health care payment system in the U.S., which is primarily based on fee-for-service, to a value-based payment (VBP) system. A VBP system is person-centered, equitable, coordinated and seeks to improve outcomes and experiences…
Many Accountable Care Organizations (ACOs) are eyeing behavioral health integration to drive down the cost of care, boost accessibility and improve overall health outcomes. ACOs work outside the traditional fee-for-service model. Instead, provider reimbursement is tied to the quality of care and overall spending reduction. While several studies have documented the impacts of behavioral health…
Hospitals with more medically complex patients, uncompensated care, and patients who live alone are more likely to receive a penalty under CMS value-based payment programs, according to a new study calling for change to the programs. The study from the Federation of American Hospitals and Dobson DaVanzo and Associates, LLC suggests value-based payment programs like the Hospital…
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…