Social determinants of health contracting with community-based organizations remains a complex and challenging task for payers as the demand for answers grows more pressing. As the industry’s awareness of social determinants of health expands, so does the need for evidence-based solutions. Often, these solutions require health insurers and health systems to contract with community-based organizations…
In 2016, Geisinger opened its Fresh Food Farmacy, a program that connects people with type 2 diabetes with fresh food weekly, social services and a care team to help them manage their health. The Pennsylvania-based health system started the program in an area that has high rates of diabetes and food insecurity, and so far,…
Fee-for-service reimbursement is still an integral part of the healthcare system as providers are scattered along a spectrum of payment models, Emily Sokol, director of research at Xtelligent Healthcare Media, explained on Healthcare Strategies. An Xtelligent Healthcare Media Insights report shed light on how pervasive fee-for-service reimbursement models are in today’s healthcare system. Over 200 providers responded to…
Speaking during a Sept. 15 eHealth Initiative panel discussion, Devdutta Sangvai, M.D., M.B.A., executive director of Duke Connected Care, said clinicians are under such stress during the pandemic that value-based care initiatives need to focus on enhancing efficiency to ease their burden. “If you can create efficiency in your value-based model, I think you’re likely…
As a doctor, it is pretty humbling to reflect on the fairly minimal impact our health care system has on individuals’ overall health. One study I find particularly intriguing shows that socioeconomic factors (e.g., education and income), and physical environment (e.g., security and safety at home and reliable access to transportation), affect a person’s health…
CMS is looking to modernize the ACO reporting process by mandating the use of electronic clinical quality measures (eCQMs). However, accountable care organizations (ACOs) are concerned that the lack of healthcare interoperability will make electronic ACO reporting near impossible. “CMS must avoid making eCQMs mandatory until standard data fields exist across EHRs, and true interoperability…
As plans prepare for Open Enrollment (OE), it’s critical to understand what beneficiaries need as these Medicare Advantage (MA) plans look to recruit new and retain existing beneficiaries. It’s also critical for plans to understand historical data in specific regions to make appropriate expansion decisions. In this blog, we will provide insight into areas that…
Accountable care organizations (ACOs) have been a large part of the transition away from fee-for-service payments, with the number of ACOs rapidly growing over the past decade. However, there has been a plateau in the number of ACOs since 2018, with ACO exits outweighing entrants for the past 2 years.1 From our analysis of Medicare Shared…
On August 26, leaders at the Downers Grove, Illinois- and Milwaukee, Wisconsin-based Advocate Aurora Health posted a press release to the organization’s website announcing breakthrough results on the part of the integrated health system’s three federal accountable care organizations (ACOs.) As the press release stated, “Data released by the Centers for Medicare & Medicaid Services (CMS) show…
The COVID-19 pandemic has forever changed how healthcare is and will be delivered in the future, Scott Gottlieb, M.D., former commissioner of the FDA, said during his keynote address today at the 2021 Pharmacy Benefit Management Institute®Annual National Conference in Orlando, Florida. The future of healthcare is going to be very different from what it is now,…