The COVID-19 pandemic has brought social and racial inequity to the forefront of public health. In the United States, the pandemic has affected many communities, including racial and ethnic minorities as well as low-income populations, more severely than other groups. Negative health outcomes are more common among individuals within these groups, and social determinants of…
The top officials at the federal Centers for Medicare and Medicaid Services (CMS) on Tuesday, Jan. 11, made a major public statement regarding the goal of moving the healthcare system towards health equity, and a major component of that statement focused on leveraging Medicare’s value-based programs, particularly those focused on accountable care organizations (ACOs) to…
As the Biden administration continues to move Medicare reimbursement from volume-based payment to payments based on value, officials are expanding those efforts to include providers who care for “traditional” Medicare patients and currently bill under a fee-for-service system. The new Direct Contracting program, a demonstration program that began under the Trump administration, allows “a broad…
The U.S. federal deficit is the highest it has ever been. Healthcare makes up the largest portion of that deficit and the COVID-19 pandemic continues to amplify the issue. Over the past few years, the Centers for Medicare and Medicaid Services (CMS) has lead the charge towards value-based contracting, which “encourages providers to deliver the…
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…
Recently, the Center for Medicare and Medicaid Innovation (CMMI) introduced their strategic refresh “Putting All Patients at the Center of Care” to support broader, more equitable, and outcome-based healthcare delivery transformation while streamlining current and future payment models. Since its inception in 2010 as a part of the Affordable Care Act, CMS has launched over 50 innovation/pilot…
Recently, The Centers for Medicare and Medicaid Services (CMS) released a proposal for it’s 2022 Physician Fee Schedule. Over the last several years, more non-traditional modalities of healthcare have found their way into the CMS reimbursement landscape. This is promising as it suggests that CMS is aligning themselves with consumer demand and technology developments by…
CMS has released the 2022 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule, and the message of these 2,414 pages is clear: CMS wants to push providers into value-based care arrangements. That intent was foreshadowed by the Proposed Rule released over the summer, which confirmed our predictions of trends under the Biden administration. Specifically, we saw a push…
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:…
The Center for Medicare & Medicaid Innovation (CMMI) in October announced a “strategy refresh” that would guide development of its future payment models. If executed effectively, the strategy could make a substantial difference in hospice and palliative care as well as the health care system at large, a trio of experts told Hospice News. The…