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…
As value-based care becomes the end goal for many healthcare organizations, health systems across the country are acquiring primary care practices to achieve this mission. Critical aspects of these acquisitions include ensuring that clinician-patient relationships are uninterrupted and establishing operations that generate value for consumers, according to Matthew Weiss, MD, managing director of the EY-Parthenon…
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…
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…
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…
CMS is proposing a nearly 8% revenue increase for Medicare Advantage plans next year, according to a proposed payment plan released Wednesday. The overall rate increase for 2023 includes a 4.75% effective growth rate and a 3.5% average increase in risk scores. The risk-adjusted benchmark trend, which analysts peg as the key number, comes out…
On November 4, 2021, the Executive VP of the ACO ExhibitHall.com (ACOEH), John Schmitt, Ph.D., MBA, served as Panel Moderator of the FLAACOS 2021 Conference session titled “How to successfully transition from fee-for-service medicine to value-based care”. He was joined by Dr. Brent Staton, CEO of CCHI (ACO), as well as Rachel Corbitt, Executive Director,…
Health systems are planning to advance their risk-based payment strategies by taking on more upside or downside risk, professional capitation, or global capitation in Medicare Advantage lines of business in 2022, according to a recent survey. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse Center for Health Insights found that…
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:…