More than a decade after accountable care organizations launched, healthcare systems are still eager to bring more skilled nursing operators into the fold, according to several acute-care speakers at the National Association of ACOs Fall Conference being held in Washington, DC, this week. Financial incentives for nursing homes to sign on to ACOs not led…
Rewards tied to improved hospital readmission rates were so small and so variable from year to year that they likely contributed to a “lack of effectiveness” for a key nursing home financial incentive program. The Skilled Nursing Facility Value-Based Purchasing program is the Centers for Medicare & Medicaid Services’ largest use of financial incentives to…
The transition from fee-for-service to value-based care (VBC) puts continued pressure on the healthcare industry, especially as organizations push to remain relevant in a competitive environment while improving patient outcomes. The primary goal of VBC is to enhance clinical results and reduce overall healthcare costs, aligning care delivery with the evolving expectations of payers and patients. Learning…
Humana Healthcare Research has released new data showing that Medicare Advantage patients with heart failure who are treated by value-based care (VBC) physicians are significantly more likely to receive recommended therapies than those in traditional care models. According to Humana’s Value-Based Care Issue Brief, patients in VBC arrangements were nearly 28% more likely to receive full quadruple therapy —…
A decade ago, the federal government launched its large-scale Medicare Access and CHIP Reauthorization Act (MACRA) in an attempt to move more physicians into value-based care to rein in exploding costs and improve care. Later this summer, Medical Economics will release the second edition of Medical Economics Insider featuring an in-depth look at how successful MACRA has been…
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 national conversation around primary care — for both the private and public sectors — is experiencing a profound shift towards prioritizing value, prevention and outcomes over wasteful spending. This transformation comes at a critical time. Despite the shortage of providers the U.S. is now facing, investment in primary care saves money and leads to better outcomes by reducing the…
The Center for Medicare and Medicaid Innovation (CMMI) has announced a refreshed strategy to promote evidence-based prevention, empower beneficiaries to achieve their health goals, and promote competition and choice in health care markets. Value-based payment (VBP) can advance that vision, but only if CMMI dramatically amplifies the will among provider organizations to fully commit to generating health…
What if a potent driver of value-based success isn’t found in your clinical programs but in the first few minutes your residents spend with your team? Long-term care is racing toward value-based care (VBC). You obsess over quality measures, satisfaction surveys and readmission rates. You invest in clinical pathways, technology and staff training. But when…
Last month, the Centers for Medicare & Medicaid Services (CMS) released its 2026 Medicare Advantage (MA) Rate Announcement, projecting a 5.06% average increase in payments to MA plans. That’s a notable jump from the 3.70% increase we saw in 2025. More than just a financial adjustment, this signals growing confidence in the Medicare Advantage model—and with…