As a concept, everyone believes that a patient should be at the center of care, supported by shared decision-making. Patients and their clinicians review the best available evidence, review the options, look at costs and benefits, and together decide how to proceed.1 In reality, in a shift from fee for service to bundled health care…
Payers should consider program design intensity when implementing value-based purchasing contracts, as higher-intensity programs can lead to better care quality and greater spending reductions, a systematic review published in Health Affairs found. Value-based purchasing programs can incorporate both financial and non-financial features. Financial aspects include bonuses, penalties, and financial risk-sharing arrangements. Non-financial aspects aim to…
Since the adoption of the 2023 Final Rule requiring ACOs to adopt Alternate Payment Model Performance Pathway (APP) quality reporting by performance year 2025, many ACOs have been scrambling to understand how to make the leap. There’s a huge difference between the old method of quality reporting using the CMS Interface to report on a…
Most people need some level of healthcare at the end of life. In fact, 25% of all Medicare spending occurs during patients’ last years, and research shows roughly 70% of adults prefer less aggressive treatments during their final days. Still, few people have frank discussions about the medical services they’d like to receive before the…
Identifying and tackling social determinants of health (SDOH) are crucial aspects of any health equity strategy. But establishing how best to capture patients’ SDOH needs and develop interventions in the clinical setting remains a significant challenge for many healthcare organizations. The United States Department of Health and Human Services (HHS) defines SDOH as “the conditions in the…
How bright is your star shining? If you’re looking to improve your Star Rating with the Centers for Medicare & Medicaid Services, you’ve come to the right place. Your Star Rating isn’t just a once-a-year focus, it’s a year-round effort. We asked our team of experts for their tips to improve your ratings. Here’s what…
CMS will test a new primary care model in eight states with the hopes of improving patient care and increasing value-based opportunities for primary care organizations. The Making Care Primary (MCP) model aims to enhance care management and care coordination, provide primary care physicians with tools to form partnerships with healthcare specialists, and utilize community-based…
A new primary care-focused payment model demonstration could create new partnership opportunities for hospice and palliative care providers. The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled the Making Care Primary (MC) model, which will launch in July 2024 in eight states — Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North…
Improving health equity in the US will require redesigning value-based payment using a set of coordinated strategies to promote equity alongside clinical, quality, and cost-efficiency outcomes. In part 1 of this article, we articulated the rationale and need for these equity-aligned design changes, and we laid out tools for tackling three design considerations in value-based…
Phase 1 enrollment in the Medicare Shared Savings Program (MSSP) for 2024 is currently underway, and recent reforms hold promise in attracting new providers into accountable care. However, experts say there’s still work for the Centers for Medicare & Medicaid Services (CMS) to do. Aisha Pittman, the senior vice president of government affairs at the…