The current ACO model is, indeed, challenging. Blending both provider and payer functions is fraught with conflict. But the provider-directed model was supposed to function closer to the actual delivery of care, and thereby be more capable of generating change. Instead, ACOs have deployed health plan strategies that were implemented decades ago, which failed to…
States that benchmark their healthcare cost growth improve transparency, strengthen primary care and boost alternative payment models, according to a new report. Eight states have implemented or are developing the regulatory and data gathering infrastructure to track annual healthcare cost growth, and more are expected to follow suit. Standardizing how those benchmarks are created and…
To advance value-based care, the Medicare Payment Advisory Commission (MedPAC) has suggested that HHS reduce its number of alternative payment models (APMs) now that it has lessons learned from a wide range of previous demonstrations. “Operating a smaller portfolio of more harmonized models, with more consistent parameters and clearer and more aligned incentives, should more…
During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…
Value-based care (VBC) is a crucial step towards improving access, equity, and quality healthcare for Americans. Since the inception of Blue Cross Blue Shield in the 1930s, the US healthcare system has relied primarily on fee-for-service (FFS) payment practices. Essentially, you go to the doctor for a specific need, the doctor serves that specific need,…
Two influential advisory groups sent recommendations to Congress calling for a revamp of how health plans are paid in the lucrative Medicare Advantage program, culling how many models CMS tests and curbing high-cost drug approvals. By many measures, the MA program has been thriving. Enrollment and participation has continued to grow, and in 2021, MA…
The healthcare industry is in the throes of unprecedented change as hospitals, providers, and payors all grapple with new methods of delivering (and billing) medical care. The uptick of value-based care, coupled with the growing prevalence of alternative therapies, makes understanding this new model a must. So, what exactly is value-based care? And why is…
Hospice providers are increasingly turning to data analytics systems to gain an edge against competitors when engaging prospective referral partners, anticipating impacts in value-based care. Data are key to demonstrating the value of hospice to potential referral partners as evolving value-based payment models take effect. The value-based insurance design demonstration project, commonly called the Medicare…
Medicare needs to streamline its portfolio of alternative payment models (APMs), the Medicare Payment Advisory Commission (MedPAC) said Tuesday in its annual report to Congress. “CMS [the Centers for Medicare & Medicaid Services] is to be commended for the vigor with which it has approached its mandate of implementing a wide variety of APMs over…
To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously,…