Medicaid expansion is close in North Carolina, with the Republican-led legislature passing and the Democratic Governor Roy Cooper signing the Access to Health Care Options legislation to take effect with passage of the state budget for the 2024 fiscal year. A distinctive feature of this result is the strong bipartisan legislative vote. Other states have…
Seventeen of the nation’s leading stakeholders in healthcare are backing a bipartisan House bill recently introduced to Congress that would reinforce Medicare’s move to value-based care. The support of the Value in Health Care Act of 2023, a bipartisan legislation that would make several important reforms to ensure alternative payment models (APMs) continue to produce…
In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they provide by rewarding them service-by-service or based on overall quality and patient outcomes. In the following article, HealthPayerIntelligence breaks…
Integrating episodes of care within your population health infrastructure can drive higher value specialty care and increase savings earned. While CMS aims to support more coordination between bundles and ACOs, organizations should set a specialty care strategy that works for them. Specialty care accounts for a disproportionate share of healthcare expenditures in the US, driven in part…
When the nonprofit behind the most popular performance measurement tool implemented health equity measures, it begged the question: how can healthcare organizations measure equity? Healthcare industry leaders recognize the importance of the overarching issue. Almost 90 percent of healthcare executives agreed that health equity should be one of the industry’s priorities. “We know what we can’t see and what…
Value-based healthcare, the holy grail of American medicine, has three parts: excellent clinical quality, convenient access and affordability for all. And as with the holy grail of medieval legend, the quest for value-based care has been filled with failure. In the 20th century, U.S. medical groups and hospital systems could—at best—achieve two elements of value-based…
Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of value-based…
Download Slides Healthcare organizations that participate in value-based care arrangements are at the forefront of transforming healthcare delivery by improving quality, patient experiences, and cost management. To excel in this pivotal role, organizations must navigate the intricate landscape of quality measure achievement. In this enlightening webinar, we will explore how digital health can revolutionize…
Reading between the many lines in the 1,920-page 2024 Medicare Physician Fee Schedule (PFS) Proposed Rule, one thing is clear: CMS is still struggling to move providers into Advanced Alternate Payment Models (APMs) and keep existing ACOs moving forward on the path to value-based payments. The APP Reporting tug-of-war between CMS and ACOs results in…
Patients who have had vascular surgeries are often readmitted to the hospital for a variety of reasons — often preventable — more often than patients who undergo different types of surgeries. These readmissions could be largely avoided if other aspects of the discharge process were improved, according to research led by the University of Missouri in Columbia….