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…
Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021, the US spent 17.8 percent of gross domestic product on healthcare, nearly twice as much as the average high-income country, a study from the Commonwealth…
The COVID-19 pandemic has taught us it’s possible for the health care system to transform care delivery—and quickly. We saw vaccines come to market in record time, heightened cross-industry collaboration to track vaccine statuses, and virtual care use surge. Similarly, the pandemic demonstrated that value-based care delivery models, where payment is based on outcomes versus the…
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…
In recent years, Medicare Advantage (MA) plans have increasingly turned their attention to addressing members’ social determinants of health (SDoH), with the home playing a crucial role. That’s according to a new report from NORC at the University of Chicago. NORC conducted the report on behalf of Better Medicare Alliance’s (BMA) Center for Innovation in…
Two influential advisory groups sent recommendations to Congress calling for a revamp of how health plans are paid in the lucrative Medicare Advantage program, culling how many models CMS tests and curbing high-cost drug approvals. By many measures, the MA program has been thriving. Enrollment and participation has continued to grow, and in 2021, MA…
Having helped several Medicare Advantage plans achieve significant quality performance improvements (up to 1.1 stars improvement YoY in 2020 alone), Stellar Health (Stellar) is sharing its perspective on what it takes to sustain and improve Star Ratings for health plans and why there is a need for action despite even a few years of success….
The Medicare Payment Advisory Commission, at its meeting on Thursday, approved several Medicare policy recommendations that will appear in its June report to Congress. The congressional advisory panel will recommend that CMS simplify its approach to alternative payment models. Commissioners approved an updated version of the recommendation presented by MedPAC’s staff at last month’s meeting….
Hu founded CarePort while she was a graduate student at Harvard. The care coordination technology company was acquired a second time last fall by Wellsky, a healthcare technology company for $1.35 billion. Senior Editor Peter Wehrwein spoke with Hu about the new CMS Direct Contracting Model, the latest addition to the value-based care menagerie, and what it…
The COVID-19 pandemic has exposed and exacerbated existing health inequities in the United States. Black and Latinx Americans have experienced a disproportionate burden of COVID-19 infections and hospitalizations due to economic disadvantages, structural racism, and higher rates of underlying chronic conditions. Value-based payment (VBP) structures have the potential to reduce health disparities, and during the pandemic, health…