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…
With all the recent buzz around generative artificial intelligence (AI) related to ChatGPT, it’s reasonable to have mixed reactions to emerging technologies. However, many AI technologies — including optical character recognition, natural language processing and machine learning — are widely established and proven highly reliable in driving healthcare innovation for payers, providers and patients. AI…
Download Slides You still have time to succeed in Traditional MIPS before it is phased out, but for that success to be meaningful, you need a forward-thinking strategy. Learn how to develop and deploy a Traditional MIPS strategy that earns incentives (and avoids penalties) now, and springboards you to future success as an APM…
The Accountable Care Organization Realizing Equity, Access, and Community Health Model (ACO REACH Model) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was developed by the Centers for Medicare & Medicaid Services (CMS). The ACO REACH Model is a redesigned and expanded version of the Global and Professional Direct Contracting (GPDC) Model. The new name and design of the survey…