In less than a decade, accountable care organizations (ACOs) have grown from nothing to caring for nearly 20% of all Medicare beneficiaries. Throughout this period of remarkable growth, quality improvement has been a critical component of Medicare ACO programs. A set of predefined quality measures incentivizes doctors, hospitals, and other providers in an ACO to provide…
The Centers for Medicare & Medicaid Services’ proposed 2022 Physician Fee Schedule offers some good news for telehealth advocates. The 1747-page draft, released this week, proposes to make permanent some provisions enacted years to address the coronavirus pandemic, while continuing most until at least Dec. 23, 2023 “so that there is a glide path to…
Physician groups are calling the Medicare Physician Fee Schedule proposed rule a mixed bag for practices, which now face a potential reduction in physician reimbursement next year, among other changes. “The proposed 2022 Medicare Physician Fee Schedule (PFS) represents a mixed bag for physician practices,” Anders Gilberg, senior vice president of government affairs at the…
As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately for health insurers, the healthcare industry has lagged in population-based payment uptake. Population-based payment models are models that are detached from fee-for-service reimbursement altogether, as opposed to other alternative…
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age; they are shaped by the distribution of money, power, and resources at global, national, and local levels. Leveraging SDOH offers tremendous opportunities in healthcare. Increasingly, evidence suggests that focusing on “upstream” interventions outside of traditional clinical care…
The transition from a fee-for-service healthcare model to value-based care (VBC) in the U.S. has continued to gain momentum in the wake of the Covid-19 pandemic. That’s because providers operating on a fee-for-service basis saw revenue fall sharply through much of last year as elective procedures were cancelled and many patients delayed primary care, even…
Public Health 4.0, or Population Health 4.0, is the recognition of health as a global entity and the focus on identifying and eliminating health disparities, unnecessary costs, and comorbidity. Unlike the previous three phases of public health, the focus in 4.0 is on population health management. As the healthcare industry moves toward a more holistic…
As the chief operating officer at a company that supports health systems and health plans in transitioning to value-based care, providers often ask me how they can best prepare their organization now for the slow-moving progression from fee-for-service to value-based care. When I am asked this question, I most often share the following anecdote: Value-based…
Hundreds of medical and social-services organizations have advocated for the passage of the Social Determinants Accelerator Act of 2021, a bipartisan House bill that would establish an interagency council on SDOH, among other provisions. As outlined in a letter sent this week by the Aligning for Health association to members of the House Energy and…
More than one-third of U.S. healthcare payments flow through an advanced payment model (APM), such as shared savings, shared risk or capitated payment. Yet for the majority of physician practices, most of their revenue is not tied to risk-based arrangements, leading to significant opportunities to participate in these models. Accountable care organizations (ACOs) can be…