Abstract This Perspective discusses the fiscal challenge facing Medicare and how that challenge may be differentially met by fee-for-service, accountable care organization (ACO), and Medicare Advantage (MA) payment systems. The non-MA part of Medicare includes both fee-for-service and ACO payment systems and is sometimes referred to as traditional Medicare. Fee-for-service, although in need of reform,…
The traditional fee-for-service (FFS) healthcare model isn’t well-suited to meet the complex needs of patients with chronic illnesses including chronic kidney disease (CKD). As costs spiral and population health declines, value-based care (VBC) presents a solution that can reshape how the healthcare system approaches CKD management and can serve as a model for how we…
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…
The Triple Aim. The Quadruple Aim. Right care at the right place at the right time. Whether one works in a hospital or small independent practice, healthcare providers are leaning on these concepts to deliver valuable care to their patients, and that is in its simplest form: care that results in the best patient outcomes…
Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force…
Year after year, surveys show the same thing: Healthcare providers’ evolution toward accepting risk to keep patients healthy—widely viewed as the holy grail of lowering healthcare costs—has been painfully slow. So long as that’s the case, experts say the financial returns providers can expect to draw from population health management, where they gather patient data…
A national primary-care physician association and an employer group have teamed up to develop a care model that aims to shift away from fee-for-service reimbursement. The American Academy of Family Physicians and National Alliance of Healthcare Purchaser Coalitions plan to leverage regional employer coalitions and physician networks to form a national primary-care model based on…
Primary care practices need new ways of being paid if they are going to survive and thrive in the wake of the COVID-19 pandemic, several speakers said Wednesday during a webinar hosted by the Alliance for Health Policy. “Fee-for-service is simply not a system this is conducive or amendable to primary care being able to thrive…
As the coronavirus sickens tens of thousands of Americans while pressuring the bottom lines of medical providers, analysts worry the pandemic could also hit pause on the decades-long march toward value-based care, as hospitals and doctors look to recoup revenue in the short-term instead of putting more dollars at risk. Massive health systems and independent physician offices alike…
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…