SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans

Garrett Schmitt,

Key Takeaways: Unmet basic needs such as social determinants of health (SDOH) impede medication adherence, chronic disease control, and appointment attendance, lowering performance on blood pressure control, diabetes A1c, kidney health evaluation, hypertension management, medication adherence (triple weighted), and all-plan readmissions measures. Interventions such as medically tailored meals, food delivery, transportation support, and closed-loop referrals stabilize…

AMGA Calls on Congress to Advance Value-Based Care, Support Providers

Garrett Schmitt, , , , , , , ,

Congress should focus on advancing value-based care by investing in proper infrastructure, incentivizing patient engagement, and supporting continuous telehealth coverage, according to the American Medical Group Association (AMGA). The organization sent a letter to congressional leaders expressing appreciation for their efforts to support healthcare providers throughout the COVID-19 pandemic. However, the letter urged leaders to improve the Medicare program…

Risk-Based Alternative Payment Models Aid Chronic Disease Management

Garrett Schmitt, , ,

Alternative payment models that put financial risk on healthcare providers improved care quality for patients with diabetes more so than fee-for-service and incentive payment programs, according to a new study published in Health Affairs. “Models that place greater financial risk on providers, such as global payment and shared savings, tend to demonstrate greater improvements in…

Three Key Decisions To Direct Your APM Adoption Strategy

Garrett Schmitt

How you ramp-up to full-scale APMs is crucial. Even if your multi-specialty group or health system receives some value-based payments with downside risk, your success hinges both on financial viability and retention of your clinicians and patients. If you delay APM adoption only after reviewing the potential on your bottom line, you’ll need to pay…

5 Imperatives For Your Value-Based Technology To Support APMs

Garrett Schmitt, ,

After years spent transforming your health care technology, you may feel like you’re almost done. But Value-Based Care Technology requires a different mindset. With reimbursement scaling to a tipping point for APM adoption, think “reboot” instead. Your health system or group has a long way to go if your aggregated and integrated data cannot support…

MedPAC Backs Simplifying Medicare Alternative Payment Models

Garrett Schmitt, ,

The Medicare Payment Advisory Commission (MedPAC) proposed streamlining Medicare alternative payment models (APMs), along with policy options for tackling pricey Part B drugs, in its June report to Congress Wednesday. In the June 2021 report, MedPAC called for reducing the number of Medicare APMs so that models running concurrently could work better together. The 2022…

Six Ways Competition Must Shape Your APM Strategy

Garrett Schmitt,

Now that you’ve made the decision to start your path to Alternative Payment Models (APMs), what’s the first thing you need to consider? Hint: APM revenue calculation does not top the list. Obviously, APM revenue generation vis-à-vis traditional Fee-for-Service is critical. But those calculations assume constancy of two essential “assets”—clinicians and patients. Your competition is…

Wanted: Better Script For Health System And Medical Group Transition To APMs

Garrett Schmitt,

Health care has been suffering for a while—just ask any participant, including patients. You will hear about burnout, pressures to perform, changes in the market, pressures of new technology, fiefdoms, consumerism, and to top it off, the buildup of competition between traditional health care enterprises and new corporate health care businesses. Then there’s the pandemic,…

Breaking Down Common CMS Value-Based Payment Programs

Garrett Schmitt, , , , ,

Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery. As the industry moves away from fee-for-service models and toward value-based care models, CMS has implemented several programs to improve patient care, advance population health, and lower healthcare costs. These value-based…

Shared Savings in Value-Based Payment Models Produce More Incentives

Garrett Schmitt, , ,

Value-based payment models that shared five-year expected savings offered stronger incentives for clinicians to implement preventive interventions for postpartum depression compared to models that offered shared savings over just one year, according to a study published in JAMA Network Open. The Affordable Care Act requires most commercial health insurance plans to cover preventive services for pregnant or postpartum…