The U.S. healthcare system’s shift from volume to value has been a trudging fifteen-year journey. Despite its potential to reduce costs and improve quality of care, the national movement toward value-based care has been harried by inconsistent guidance, confusion and misalignment among payers and providers, and subsequently mixed success across various payment models. Adoption among…
All ACOs, regardless of payment model, are built on a vision of primary care services to patients. Medicare attributes patients to your ACO based on the plurality of primary care services. CMS attributes a patient to a participating specialist only if the patient has not seen a primary care physician in the ACO or at…
Most agree health disparities are a moral problem. Yet there are disagreements about how to reduce them. Some believe that in health systems, equity and efficiency are incompatible, requiring stark and painful tradeoffs. Others, myself included, believe that achieving equitable health outcomes can, in fact, be accomplished by improving efficiency. The existing structure of the…
Download Slides The Centers of Medicare and Medicaid Services (CMS) announced all patients will be in a care relationship with accountability for quality and total cost of care by 2030. Become an ACO today to practice before it becomes mandatory. CMS is offering up to $5.6 million in funds to help cover start up…
As value-based care becomes the end goal for many healthcare organizations, health systems across the country are acquiring primary care practices to achieve this mission. Critical aspects of these acquisitions include ensuring that clinician-patient relationships are uninterrupted and establishing operations that generate value for consumers, according to Matthew Weiss, MD, managing director of the EY-Parthenon…
Many referral decisions for post-acute care hinge on electronic order capability and interoperability, according to a new survey of more than 130 hospital and physician entities. Referrals are a vital part of the US healthcare system, with over a third of patients receiving specialist referrals annually. As such, obtaining a referral is a relatively common…
When it comes to value-based payment models, home health has a head start on hospice. But those providers’ experiences can lend some insights into how hospices can prepare themselves. Hospices are only now taking their first steps into value-based reimbursement. To date, much of this has centered around diversified programs like palliative care, PACE and…
Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models. Industry advancements in value-based care (VBC) have resulted in a meaningful restructuring of health plan and provider organizations, processes and…
Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund. Full Article
Download Slides Accountable care organizations (ACOs) leverage data and population insights to mitigate risk and improve patient health outcomes, and this starts with access to preventive care. Gap closure programs for preventive care include services such as screenings, annual visits, vaccinations, and more. However, only 8% of U.S. adults receive recommended preventive care. First…