On July 16, 2025, the Centers for Medicare and Medicaid Services (CMS) released a Notice of Proposed Rule Making (NPRM) for CY 2026. The proposed rule indicates that CMS wants to accelerate risk within its programs with the expectation that doing so will drive better results. However, many entities are not ready, and the current quality…
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…
When the nonprofit behind the most popular performance measurement tool implemented health equity measures, it begged the question: how can healthcare organizations measure equity? Healthcare industry leaders recognize the importance of the overarching issue. Almost 90 percent of healthcare executives agreed that health equity should be one of the industry’s priorities. “We know what we can’t see and what…
Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of value-based…
With the public health emergency extended to April, providers get additional time to use waivers for telehealth and other flexibilities. Aside from these flexibilities, the public health emergency holds accountable care organizations harmless from financial losses for the months in which the PHE is in effect. For example, if the PHE is in effect for six months in 2021,…