In November 2021, the Centers for Medicare & Medicaid Services (CMS) announced a strategy to achieve near-universal participation in value-based payment models by 2030. Core to this strategy is the goal that every beneficiary should be in a clinical care relationship that has accountability for quality and total cost of care. Achieving this goal will…
Partnering with private consulting firms could prompt hospitals to participate in a greater number of episodes in a federal bundled payments program, according to new research. The voluntary Bundled Payments for Care Improvement initiative Advanced Model, or BPCI Advanced, compares spending for specific clinical episodes, like congestive heart failure or sepsis, with benchmarks set by the Centers…
For Rep. Suzan DelBene, D-Washington, a major proponent of legislation in Congress on value-based care, a key driver is making sure that providers have the tools to succeed in payment models and figuring how Congress can help make that happen. DelBene is the lead sponsor in the Value in Health Care Act, bipartisan legislation recently…
One critique of many of the value-based program launched by CMS is that they have been voluntary. That self-selection clouds results, goes the critique, because hospitals (and physician practices) that elect to participate in a program likely have attributes going into the program that will make them successful. As a result, favorable outcomes or spending…
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,…
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…
The success of bundled payments hinges on a variety of factors — some ASC leaders are wary, while others have found success in value-based payments. Four healthcare leaders spoke with Becker’s ASC Review on how value-based care is affecting their practices. John Lewis, CEO of Semmes Murphey, a brain and spine clinic in Memphis, Tenn.,…
Healthcare is not only expensive, unfortunately, it’s also wasteful. In fact, nearly $760 billion annually is spent unnecessarily in healthcare, according to a recent study published in JAMA. In addition to identifying the problems within healthcare, the researchers of the JAMA study also suggested methods of addressing waste. One such solution is greater adoption of value-based payment programs. Primarily…
The move to value-based care is not happening a year from now, or in a month, or even tomorrow. It’s happening as we speak. Why do I say that? An analysis from the Health Care Payment Learning & Action Network (HCP-LAN) in October 2018 revealed that 34% of healthcare dollars of 2017 flowed in from Alternative Payment…
The reason CMS Alternative Payment Models (APMs) are failing to significantly reduce spending in Medicare is that none of the major APMs meets the majority of the eight criteria for a successful APM. The Problems with Medicare’s Alternative Payment Models and How to Fix Them details the serious weaknesses in the six major Advanced APMs that have…