Integrating care for people dually eligible for and enrolled in Medicare and Medicaid remains a bipartisan policy priority. Because Medicare and Medicaid are administered and funded separately, most dual-eligible beneficiaries receive coverage through two distinct programs with separate budgets, which lack financial incentives to coordinate care. To address these misaligned payment incentives, much of policy makers’ efforts…
On July 4, President Donald J. Trump signed into law the legislation and spending plan known as the One Big Beautiful Bill Act (OBBBA). The bill has a number of effects across different sectors of the economy, including health care. This slideshow compiles some facts, figures and responses from a variety of sources that analyzed…
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. In July, Medical Economics will release the second edition of Medical Economics Insider featuring an in-depth look at how successful MACRA has been and what…
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…