Person-centered care is a framework that healthcare payers and providers use to ensure care plans address the full spectrum of health-related needs that members face, including medical, behavioral, and social determinants of health (SDOH). In contrast to other models of care, a person-centered approach to care recognizes that each member deserves a care plan that…
The pace of change in the healthcare industry is accelerating with new therapies promising cures to previously debilitating or deadly diseases. Aging populations, and public health crises, such as addiction to opioids, are putting pressure on provider workloads and increasing patient safety risk and negatively affecting patient experience. Healthcare providers must rise to the challenges…
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,…
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…
Dive Brief: Medicare ACOs with a higher proportion of primary care physicians with patient-centered medical home experience were more likely to generate savings and demonstrate higher quality scores, according to the Patient-Centered Primary Care Collaborative’s (PCPCC) 2018 Evidence Report. Researchers grouped 333 ACOs into quartiles from no PCMH experience (Q1) to 43% PCMH primary care physicians…
The shift toward value-based payment in healthcare that countless advocates say will cut costs and improve the quality of care isn’t without its downsides. This week’s earnings show the evolution is weighing on some providers’ bottom lines. As more of Universal Health Services’ behavioral health patients move from fee-for-service Medicaid to Medicaid managed-care programs, the…
Orlando-based Florida Hospital President and CEO Daryl Tol said during a recent talk that the hospital has created a secret team called Project Fulcrum to “kill the old healthcare model,” according to the Orlando Sentinel. Here are three things to know: 1. Mr. Tol, who also serves as president and CEO of the central Florida…
ABSTRACT: Objectives: Accountable care organizations (ACOs) are groups of healthcare providers responsible for quality of care and spending for a defined patient population. The elimination of low-value medical services will improve quality and reduce costs and, therefore, ACOs should actively work to reduce the use of low-value services. We set out to identify ACO characteristics…
When Rob Lazerow, a managing director at the Advisory Board Co., recently met with the executive team of a large health system, he noticed a construction project had been downsized from the prior year. The organization decided to replace its aging facilities with smaller structures, which would potentially allow it to fine-tune its staffing model…
Payers that implemented value-based payment models reduced healthcare costs by an average of 5.6 percent, improved provider collaboration, and created more impactful member engagement, according to a new study from Change Healthcare. The Finding the Value: The State of Value-Based Care in 2018 report, presented at the 2018 AHIP Expo, found that payers are effectively…