The healthcare industry is at a critical inflection point and the promise of value-based care is at risk due to operational complexity and clinician burnout. AI offers a potential lifeline to streamline processes and restore focus on patient care. However, widespread adoption is stalling. Concerns around trust, transparency, and usability are slowing progress. This isn’t just…
When the Centers for Medicare & Medicaid Services (CMS) launched the Transforming Episode Accountability Model (TEAM) and the AIM for Health Equity and Accountable Care Growth (AHEAD) model, it wasn’t tinkering with policy at the margins — it was redefining what hospitals are accountable for. The new rules make one truth unavoidable: the hospital’s responsibility doesn’t…
It takes a village. Moving toward value-based care (VBC) in the U.S. healthcare system requires engagement and cooperation from multiple players. Stakeholders include accountable care organizations, social service and community-based organizations, multiple payers, and a range of providers. Ideally, these groups and individuals work seamlessly together to create multiple policies and payment strategies inherent to VBC…
During the pandemic, health care providers and institutions ramped up innovative, sustainable and increasingly digital ways to improve population health outcomes, and I expect this trend to continue. For over 20 years, I’ve advised health care provider teams across the U.S. on leveraging and incorporating digital technology and tools like patient portals, health trackers and…
In early 2020, healthcare leaders from payers to providers to technology services providers found themselves at a crossroads—innovate or fail to care for patients. I had the privilege recently of joining a virtual roundtable with a group of healthcare leaders to talk about the transformation of patient care, engagement and outreach. The panel focused on…
Many researchers working on health technology assessments (HTAs) are keen to address disparities in health care. But the COVID-19 pandemic and recent prominence of the Black Lives Matter movement have cast a bright spotlight on structural racism in the US and elsewhere, showing that addressing health disparities after they are established is both too late and…
The Guidehouse Center for Health Insights has just released analysis of an executive survey in conjunction with HFMA, the 2021 Risk-Based Healthcare Market Trends, that found health systems appear to be going big into risk sharing in 2022, with these percentages of respondents planning to advance into upside/downside risk sharing, professional capitation or global capitation for:…
Specialists are key partners for delivering value-based care, particularly for patients with chronic diseases. This involves the appropriate diagnosis of conditions, including rare diseases, stewardship of diagnostics and value-based prescribing for specialty medications. Lawrence Kosinski, M.D., MBA, founder and chief medical officer of SonarMD, a tech-enabled care coordination solution for digestive health, notes the great…
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…
As the chief operating officer at a company that supports health systems and health plans in transitioning to value-based care, providers often ask me how they can best prepare their organization now for the slow-moving progression from fee-for-service to value-based care. When I am asked this question, I most often share the following anecdote: Value-based…