Health inequities in the United States are persistent and pervasive, resulting from well-documented discrimination inside and outside the health system. These inequities are both preventable and treatable. Reforming how we pay for care is one of the many tools the health system has to improve equity. Yet reform efforts have fallen short and have only recently begun to…
In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they provide by rewarding them service-by-service or based on overall quality and patient outcomes. In the following article, HealthPayerIntelligence breaks…
Equity was at the forefront of Reuters’ value-based health conference in Philadelphia last month. Over two days, executives from accountable care organizations, health systems and payers spoke about interoperability, population health, social determinants, the cost of care and taking on risk. Across the board, speakers agreed that the transition to value-based care (VBC) is both…
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…
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…
Medicare Advantage plans may provide better access to care and lower healthcare spending for enrollees, compared to fee-for-service Medicare, according to a study from ATI Advisory conducted on behalf of Better Medicare Alliance (BMA). “Medicare Advantage continues to demonstrate that it offers important cost protections and value for Medicare Advantage beneficiaries,” said Allison Rizer, principal at ATI Advisory…
Medicare Advantage beneficiaries whose primary care organization participated in a value-based payment model saw lower rates of hospitalizations, observation stays, and emergency department visits, according to a study published in JAMA Network Open. Value-based payment models incentivize providers to deliver quality care while keeping healthcare spending low. As stakeholders see positive results, Medicare and Medicare Advantage plans have shifted toward…
More than 200 healthcare organizations, including America’s Physician Groups (APG) and the National Association of ACOs (NAACOS), have urged the Department of Health and Human Services (HHS) to make adjustments to the Global and Professional Direct Contracting Model instead of canceling the program. In a letter to HHS Secretary Xavier Becerra, the groups stressed that shutting down the Direct…
Medicare Part C (Medicare Advantage) enrollment has grown more rapidly than fee-for-service Medicare Enrollment in the last decade, raising questions about changes in the characteristics of different enrollee populations for Medicare Part A only, Medicare Part A & B and Medicare Part C. Microsoft’s Precision Population Health Group partnered with CareJourney to advance understanding of…
In order to ensure accountable care organization (ACO) and patient experience success, providers must collaborate across the continuum of care, suggested a recent study out of the Ohio State University Fisher College of Business. “We found that if an ACO wants to be successful, it needs representation across all parts of a patient’s continuum of care,”…