Machine learning is getting better at predicting things. There are now algorithms that improve the detection of diabetic retinopathy, predict the onset of sepsis, and help determine a critically ill patient’s risk of dying. But a piece of wisdom from Warren Buffet comes to mind: “Predicting rain doesn’t matter. Building arks does.” Even the most…
The rise of value-based care has put a greater focus on costs and quality of all health care providers. While accountable care organizations (ACOs) have gotten a bad rap in the skilled nursing industry in the past, joining forces with these groups, which consist of groups of doctors, hospitals and other health care providers, remains a…
The current pandemic will likely have significant negative long-term consequences on health, with the economic downturn, job losses, social and emotional effects of social distancing and sheltering, and disruption to routine health care and education. These pressures exacerbate the existing shortfall of investment in social determinants of health (SDOH). Looking ahead, finding mechanisms to unleash…
There is increased recognition for better methods to measure, predict and adjust for social risk factors in healthcare and population health. Current performance and quality measures generally do not take SRFs into account in the bonus/penalty structure, nor are SRFs generally included in most risk adjustment formulas. This can lead to unintended consequences, including the…
Value-based care has become a buzzword over the past decade with early experiments in Massachusetts, followed by creating Medicare accountable care organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments. Much of…
While I am a practicing clinician, I am a firm believer that improvements in healthcare most often come from borrowing the best ideas from other business models. For example, I have sometimes borrowed from software company and payer colleague insights to describe value-based care (VBC) reimbursement as a subscription model. This model would provide more…
Over the past decade, adoption of value-based payment (VBP) models has increased substantially. The Center for Medicare and Medicaid Innovation’s has launched multiple new models since its authorization, commercial payers have structured almost one-third of their payments as alternative payment models (APMs), and state Medicaid programs have increasingly included payment reforms in their waivers and…
There’s a growing awareness among employers, community advocates, and the public health sector that issues of diversity, equity, and inclusion (DEI) must be addressed in the healthcare ecosystem if we are to implement genuine value-based care (VBC). Unlike traditional fee-for-service healthcare, VBC emphasizes keeping people well over “sick care.” As a holistic approach to healthcare,…
New bipartisan legislation aims to fix a glitch that can penalize rural accountable care organizations that reduce costs. The legislation, introduced Tuesday, would fix a flaw that requires all ACOs to measure their performance against themselves, which lawmakers say can disproportionately impact rural providers. The bill comes as ACO advocates have been worried about a…
Sustainable health care systems should be focused on outcomes instead of reimbursing for the services provided. Critical levers for accelerating this are patient engagement and a more comprehensive, standardized collection of patient outcomes. Also, more expertise is required on how these data can best be incorporated into the care process. The Innovative Medicines Initiative project,…