In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they provide by rewarding them service-by-service or based on overall quality and patient outcomes. In the following article, HealthPayerIntelligence breaks…
Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021, the US spent 17.8 percent of gross domestic product on healthcare, nearly twice as much as the average high-income country, a study from the Commonwealth…
Although accountable care organizations (ACOs) appear to be saving money for Medicare, they haven’t caught on as fast as proponents would like. As part of our occasional series of interviews with members of Congress, MedPage TodayWashington Editor Joyce Frieden spoke with Rep. Suzan DelBene (D-Wash.) about her legislation to improve ACOs and encourage more physicians to sign up…
When asked about government’s influence and impact on healthcare, I like to cite my friend, former Health and Human Services (HHS) Secretary Michael Leavitt, who says, “If you want to change healthcare you have to change Medicare.” Everybody else—the commercial insurers and the providers—will follow. But changing Medicare is hard. As we’ve seen, even with…
Understanding the full impact of the COVID-19 pandemic on the healthcare industry is not yet possible, but a few outcomes are evident. Medicaid and Affordable Care Act (ACA) enrollment rates are surging alongside the unemployment rate.1 In addition, postponed procedures and delayed routine services—as well as pent-up demand for elective procedures—will soon drive increased utilization….
Dive Brief: The Biden administration has paused or pulled some models testing value-based payments in healthcare, but the new director of the CMS agency overseeing model testing said the slowdown doesn’t equate to waning motivation for its mission. Elizabeth Fowler, who took the reins at the Center for Medicare and Medicaid Innovation a few months ago, said…
The healthcare system is at a critical point in its transition to value-based care a decade after implementation of the Affordable Care Act and its Center for Medicare and Medicaid Innovation (CMMI), according to CMMI’s newly minted director Liz Fowler, PhD, JD. “The goal [of the ACA] was to create a system that rewards better…
A lot has happened in health care since 2012, when final rules permitted provider-organized ACOs to be the driving force of Value-Based Care under the 2010 Affordable Care Act (ACA). As we pass the ACA’s eleventh anniversary, a dwindling number of Medicare Shared Savings Program (MSSP) ACOs are entering a new phase marked by higher…
Everyone who’s reeling from 2020 is hoping for light in 2021. Health care, especially—systems, hospitals, clinical practices and their providers—wants the pain to stop. What might lie ahead for health care next year? Here’s what we’re thinking about the near future, and what you should watch for in 2021. 1. Health care providers will be…
The Affordable Care Act was passed in 2010 with the goals of controlling healthcare costs and decreasing the number of people without health insurance. While progress has been made to expand coverage (the percentage of uninsured Americans dropped from 17% in 2003 to 12% in 2018), overall expenditures continue to rise. In the United States today, healthcare…