HHS needs to expand the list of social determinants of health that public payers can cover and hold public payers accountable to covering preventive services that can help address social determinants of health, the Bipartisan Policy Center said in a report. “The U.S. can improve population health and health outcomes by integrating social services with the…
Value-based care has gained significant traction in the U.S. over the past few years, and for good reason. With healthcare costs outpacing income growth and health insurance deductibles increasing by 212% over the past decade, many patients are left feeling that their health insurance doesn’t provide as much value as it did 10 years ago….
Extensive research and the pandemic have elevated the importance of addressing social determinants of health (SDOH) to improve health and reduce longstanding disparities in health and health care.1 Social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Prior…
As Medicare Advantage continues to serve a proportionally higher-risk and more diverse enrollment population, a new report highlights innovative approaches to addressing social determinants of health (SDOH) for Medicare Advantage beneficiaries, while acknowledging barriers that remain. Social determinants of health are non-medical factors that account for up to 55% of an individual’s health outcomes, according…
Understanding the full impact of the COVID-19 pandemic on the healthcare industry is not yet possible, but a few outcomes are evident. Medicaid and Affordable Care Act (ACA) enrollment rates are surging alongside the unemployment rate.1 In addition, postponed procedures and delayed routine services—as well as pent-up demand for elective procedures—will soon drive increased utilization….
During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…
Industry expert David Smith, Founder and CEO of Third Horizon Strategies, provides an overview of CMS’s value-based initiatives with specific perspectives on the new administration’s Medicare/Medicaid philosophy, the rise of complex care management, and Medicaid Advanced Payment Models. He also shares an update on the core CMS payment models including MIPS, ACOs, and BPCI, as…
Medicaid accountable care organizations (ACOs) have not grown as quickly as industry experts anticipated, according to a new report from Leavitt Partners. ACOs with at least one Medicaid contract accounted for just eight percent of all ACOs by the end of 2018, the healthcare intelligence business found using ACO data from their Torch Insight database. In other…
To drive down health care costs and improve outcomes for patients with chronic illnesses, New York’s Northwell Health hospital system is training health care workers who can better relate to—and help—people from underserved and largely minority communities. Less than a year old, Northwell’s program has trained nearly 30 people to become community health workers, a…
The shift toward value-based payment in healthcare that countless advocates say will cut costs and improve the quality of care isn’t without its downsides. This week’s earnings show the evolution is weighing on some providers’ bottom lines. As more of Universal Health Services’ behavioral health patients move from fee-for-service Medicaid to Medicaid managed-care programs, the…