Over the last decade, as health care solutions have become more specialized and fragmented, primary care physicians (PCPs) have frequently been cut out of the loop, particularly in coding initiatives. Retrospective and in-home risk assessment solutions work around PCPs. This dynamic further complicates PCPs’ ability to thrive in value-based care, which hinges on primary care…
The COVID-19 pandemic has impacted every aspect of life in the US and challenged the capacity of the health care system like no other event in modern times. While policy makers struggle with how to deploy and rebuild the public health infrastructure and the biomedical and pharma industries race to a vaccine and therapeutic cures,…
With the change of administrations that will be coming in January, the leaders of the Washington, D.C.-based National Association of ACOs (NAACOS), which represents hundreds of accountable care organizations nationwide, on Thursday, Nov. 12, published an outline of what they consider to be successful ACO models, and NAACOS’s president and CEO has published an analysis…
In a recent post, the administrator of the Centers for Medicare and Medicaid Services (CMS) reported that the Medicare Shared Savings Program (MSSP) generated $2.6 billion in gross savings in 2019 and $1.2 billion in net savings after accounting for shared-savings payments to participating accountable care organizations (ACOs). Achieving this level of savings would constitute remarkable…
Communities across the United States are looking for better ways to manage mental and behavioral health disorders, with the recognition that Social Determinants of Health (SDOH) are inextricably linked with an individual’s mental health status. This is particularly true among individuals with comorbid medical conditions. Broadly put, SDOH are the complex political, socioeconomic, and cultural circumstances into…
Summary: Health care systems across the world have increasingly embraced a value-based health care (VBHC) agenda. They do so for different reasons, using different foundations, and variations on the tools and tactics to effect their strategic goals. The role of governments, providers, and private payers varies, as do funding and payment schemes. In their review…
Implementation of accountable care organizations (ACOs) has been occurring unevenly across the nation, with rural areas lagging behind their more urban counterparts in ACO establishment (for example, see here, here, and here). To help establish ACOs in more areas of the country, the Centers for Medicare and Medicaid Services (CMS) developed the ACO Investment Model (AIM) to provide participating ACOs…
With the results of the presidential election and the race for control of the Senate still undecided, it’s also not entirely clear what will happen to the many healthcare issues facing Congress, the president, and federal agencies. We asked experts to discuss the possibilities under a Trump administration or a Biden administration, and how a…
A 2015 law passed by Congress sought to put Medicare on a financially sustainable path by incentivizing participation in alternative payment models (APMs), which are designed to make doctors and hospitals financially accountable for lowering patients’ medical spending and improving quality. That law, the Medicare Access and CHIP Reauthorization Act (MACRA), provides bonuses for participating…
Individuals with a serious mental illness (SMI) often present with complex co-morbid conditions as well as social, occupational and legal challenges that may exacerbate symptoms and lead to over utilization of Emergency Departments (EDs) and crisis stabilization services. LSF Health Systems, a behavioral health managing entity overseeing a network of more than 60 provider…