While the HITECH Act of 2009 spurred widespread EHR adoption across healthcare organizations, national health information exchange (HIE) investments have largely left out community-based referral organizations, limiting social determinants of health (SDOH) data interoperability. SDOH data exchange is key for improving population health, with factors such as housing, food and nutrition, transportation, and education accounting…
Health system executive teams are in a bind as expenses rise faster than reimbursement rates, and margins are expected to stay slim for the next few years. With few options to mitigate costs and avoid cutting services, layoffs or worse, hospitals and health systems are accelerating value-based care strategies and taking a more nuanced approach…
“We have providers all the time saying, ‘I want a value-based contract.’ But when you ask them why, they have no idea.” — Chasity Howell, Vice President of Provider Relations for Indiana Medicaid MCO MDWise “Value-based care really is a shift in the paradigm. Providers deliver care on an individual patient level. Now, we’re asking…
Most Americans support the idea of value-based care but don’t understand or resonate with the term, according to new research from United States of Care. USofCare is a self-described nonpartisan think tank focused on building a more equitable healthcare system. Its latest research relied on (PDF) virtual focus groups with a dozen participants, a national…
Value-based care models incentivize healthcare providers to improve care delivery by tying reimbursement to care quality. While value-based care holds providers more accountable for patient health outcomes, it also affords them the resources and time needed to improve care quality. As of 2021, nearly 60 percent of healthcare payments stemmed from value-based models, according to…
With the current administration of President Joe Biden, the U.S. Centers for Medicare & Medicaid Services (CMS) continue to make health equity a key aspect of value-based care. Studies are increasingly detailing how the conditions in which people are born, grow, live, work, and age – what are known as the social determinants of health…
CMS has announced revisions to the ACO Realizing Equity, Access, and Community Health (ACO REACH) model to improve health equity and predictability for participants. Full Article
ACO REACH, which began its first model year in January, is a redesign of CMS’ controversial direct contracting model that’s meant to tie traditional payments in Medicare to value and improve care coordination. Regulators shelved the direct contracting program last year, after some progressives slammed the model as a thinly veiled effort to privatize the Medicare…
Health inequities in the United States are persistent and pervasive, resulting from well-documented discrimination inside and outside the health system. These inequities are both preventable and treatable. Reforming how we pay for care is one of the many tools the health system has to improve equity. Yet reform efforts have fallen short and have only recently begun to…
If CMS’s new proposed option for APP Reporting becomes part of the Final Rule, ACOs will have the ability to limit quality reporting to Medicare patients only. Your ACO must now determine whether reporting Medicare-only patients saves work and money and best demonstrates your quality. Use these Roji TIPS to decide what approach will work…