The U.S. spends huge amounts of money on health care that does little or nothing to help patients, and may even harm them. In Colorado, a new analysis shows that the number of tests and treatments conducted for which the risks and costs exceed the benefits has barely budged despite a decade-long attempt to tamp…
The U.S. healthcare system’s transition to value-based care might be slowed by current financial conditions, according to an October 2023 report published in NEJM Catalyst. In June, 915 members of an NEJM Catalyst Insights Council — composed of clinicians, clinical leaders and executives at organizations directly involved in care delivery — were surveyed about their…
As Value-Based Care expands, payers are emphasizing cost reduction all the more. Newer CMS payment models like ACO REACH reinforce cost control by capping reimbursement in total global payments to ACOs. In turn, global payments enable ACOs to directly negotiate rates with preferred provider specialists. In addition to focusing on controlling costs delivered through primary…
Healthcare quality reporting is evolving, and accountable care organizations (ACOs) are at the forefront of this change. In 2025, ACOs will be required to shift from traditional quality reporting via the CMS Web Interface to electronic clinical quality measures (eCQMs), marking a significant transition in their reporting process. This transformation aims to enhance patient care…
Unmet caregiver needs are a top issue to address in developing end-of-life care models encircling the Medicare landscape. Among top priorities in current and future payment models is to improve care for those with serious and terminal illnesses, which includes caregiver support, according to Purva Rawal, chief strategy officer for the Center for Medicare and…
Download Slides Referral management is vital to the success of a value-based care organization, however managing referrals across disparate EMRs is difficult. Many organizations still rely on manual and outdated processes to manage these workflows. Poor referral management affects cost, quality of care, and patient and staff experience. Join us for an expert panel…
As hospices prepare for Medicare Advantage, more nonprofits are finding that creating partnerships or entering affiliations will better position themselves for payer negotiations. Nonprofit hospice affiliations have surged in 2022 and 2023. This is in addition to the creation of several regional collaborative networks and the formation of new Accountable Care Organizations (ACOs). The gradual…
Only 21% of primary care physicians feel they are fairly compensated, according to a new report released by Pearl Health, a tech company that helps independent physician practices participate in value-based care models. For the report, the company collected survey responses from 202 primary care physicians from July 11 to October 9. Recent data shows…
Download Slides Join Thomas Martin, Senior Director of Data Insights at WellSky and Devin Woodley, Vice President of Managed Care Contracting at VNS Health, as they explore the characteristics of successful home health agencies and how performance measures such as quality ratings, response times, and readmission rates influence referral decisions. In this session, Devin…
As they gain experience with alternative payment models, how can healthcare executives do a better job of partnering with community-based organizations (CBOs) to address patients’ health-related social needs and decide what is meaningful to measure? A panel of innovators at the Health Care Payer Learning & Action Network (LAN) Summit in Washington, D.C., described their…