The U.S. Attorney’s Office has filed a complaint under the False Claims Act against Steward Health Care System and its subsidiaries, alleging violations of the physician self-referral law and submission of false claims to Medicare. The government announced the filing of its complaint against the Dallas-based Steward system, Steward Medical Group and Steward St. Elizabeth’s…
The business of healthcare has evolved significantly over the last two decades as stakeholders, from providers to policymakers, have looked for ways to manage costs while improving patient outcomes and achieving health equity. More and more independent practices have been purchased by health systems, offering economies of scale while promoting provider accountability for the delivery…
Key Points Question Was the Medicare Shared Savings Program (MSSP) associated with net savings to the Centers for Medicare & Medicaid Services (CMS)? Findings In this economic evaluation using estimates from 2 studies and data on MSSP incentive payments for MSSP performance years 2013 to 2021, the MSSP was associated with net losses to traditional…
Summit Re is a managing general underwriter and reinsurance advisor working with health insurers, managed care organizations, ACOs, and self-funded employers throughout the US. Summit Re promises a consistent, fair, and effective underwriting methodology that factors in the unique characteristics and experiences of their customers and their businesses in order to produce the best…
Download Slides Artificial Intelligence is flowing into every aspect of services and products, and nowhere is its potential greater than in health care. AI has already made rapid progress possible in improving diagnostics, and person-based precision treatments are on the horizon. So, too, is AI-enabled Value-Based Care solutions that better identify and target patients…
Researchers from the University of South Carolina School of Medicine and Arnold School of Public Health recently conducted a study to determine what factors may interfere with patients completing SDoH screenings with their primary care providers. Though more and more health systems have recognized the impacts of nonclinical factors, such as food, housing, and transportation,…
Download Slides There are hundreds of quality measures used to profile post-acute providers, but how do hospitals and their post-acute partners know which of those measures are most relevant? With the onset of COVID-19, Mount Sinai Health System quickly recognized the need for more comprehensive insights and a data-driven approach to partnering with post-acute…
AI in healthcare and value-based care enablement are top developing trends in healthcare, but lack scalability so far, while big box retailers as providers and data interoperability have shown a high volume of activity in 2023, and are scaling with long-term trajectories. Rock Health’s report, which utilized data to determine the sequence of developments in…
ACOs just gained a reprieve from implementing all-patient APP quality reporting in 2024. A provision in CMS’s Physician Fee Schedule Final Rule, which goes into effect on January 1, 2024, enables ACOs to report on Medicare patients only, based on CMS provision of eligible patient lists for three APP measures. If your ACO decides to…
During last week’s Primary Care Transformation Summit, Amy Nguyen-Howell, M.D., M.B.A., chief of the Office for Provider Advancement at Optum Health, and Nwando Olayiwola, M.D., M.P.H., chief health equity officer and senior vice president at Humana, detailed the data infrastructure they are building in their respective organizations to support health equity initiatives. As Humana’s first…