With the changing healthcare landscape that is moving towards value, it is imperative for organizations to find and recruit high performing providers that will continue to drive high quality care at a lower cost. One of the ways to provide high-quality and efficient care is to build and expand your high-performance networks (HPNs). However, health…
Over the last decade, members of the medical and public health communities around the world have widely studied and acknowledged the impact of social determinants of health (SDOH)—the conditions in the environments where people live, learn, work, play, and age—on a wide range of health, functioning, and quality-of-life-risks and outcomes.[1] In the past year or…
In less than a decade, accountable care organizations (ACOs) have grown from nothing to caring for nearly 20% of all Medicare beneficiaries. Throughout this period of remarkable growth, quality improvement has been a critical component of Medicare ACO programs. A set of predefined quality measures incentivizes doctors, hospitals, and other providers in an ACO to provide…
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age; they are shaped by the distribution of money, power, and resources at global, national, and local levels. Leveraging SDOH offers tremendous opportunities in healthcare. Increasingly, evidence suggests that focusing on “upstream” interventions outside of traditional clinical care…
The transition from a fee-for-service healthcare model to value-based care (VBC) in the U.S. has continued to gain momentum in the wake of the Covid-19 pandemic. That’s because providers operating on a fee-for-service basis saw revenue fall sharply through much of last year as elective procedures were cancelled and many patients delayed primary care, even…
Payers may be prepared to comply with the interoperability rule for the July 1 deadline, but are they ready to adopt healthcare interoperability long-term? For the past couple of years, CMS has pushed the industry to take bigger steps toward standardizing interoperability. “CMS continues to build on its roadmap to improve interoperability and health information…
Nationwide, accountable care organizations report that it’s becoming more challenging to do business and the stakes are higher than ever. They are taking on more financial risk as CMS shifts Medicare Shared Savings Program ACOs into downside or two-sided risk tracks. Meanwhile, patients are aging, chronic conditions are on the rise and more specialists are…
The healthcare industry in the U.S. has spent a whole generation talking about moving from a fee-for-service to a value-based model, focusing more on improved patient outcomes and early interventions rather than disease treatment. This shift has occurred gradually, sometimes purposefully, and sometimes in fits and starts, but overall, it has been slower than expected….
To say that hospitals and health systems have had to do more with less in the past 18 months is the understatement of a lifetime. These organizations have faced more than their fair share of unexpected challenges – from spiking patient demand, increasing costs and lost revenue, to overworked staff, a downturn in elective procedures…
The current ACO model is, indeed, challenging. Blending both provider and payer functions is fraught with conflict. But the provider-directed model was supposed to function closer to the actual delivery of care, and thereby be more capable of generating change. Instead, ACOs have deployed health plan strategies that were implemented decades ago, which failed to…