How Payers Are Linking Community-Based And Value-Based Care To Strengthen Outcomes And Equity

January 6, 2022acoPayers, value-based care, vbc

Like politics, it’s been said that all healthcare is local. But when it comes to the role of community-based organizations (CBO) in supporting health, payers and other stakeholders haven’t quite known how to include their closest neighbors. Add to this the rising importance of social determinants of health (SDOH), which CBOs may be qualified to…

Key Characteristics for Successful Downside Risk Contracting

October 15, 2021Garrett SchmittNo Commentscontracting, downside risk contracting, healthcare payers, KLAS, Payers, Population Health, Population Health Management, Risk, risk contracting, risk management, value-baed reimbursement, value-based care, value-based contracting, VBR

Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the…

Providers are putting more focus than ever on health equity. Here’s how payers can support them

October 11, 2021Garrett SchmittNo Commentshealth equity, healthcare disparities, healthcare equity, Payers, SDOH, social determinants

Health equity is increasingly a priority for providers, and insurers can be a key partner in supporting those efforts, according to the Institute for Healthcare Improvement (IHI). More than half of health systems surveyed (58%) identified health equity as a top priority, up from 25% saying the same in 2019. Equity placed second to safety in the…

Expanding Social Determinants of Health Benefits Among Public Payers

October 11, 2021Garrett SchmittNo CommentsBipartisan Policy Center, HHS, Medicaid, Payers, preventive care, public payers, SDOH, social determinants of health

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…

Developing value-based virtual partnerships: What health plans should know

September 9, 2021Garrett SchmittNo CommentsCOVID-19, health plans, pandemic, Payers, SDOH, Telehealth, value-based care, vbc, virtual partnerships

If there’s a silver lining to the Covid-19 pandemic, it’s the spotlight it has put on the role of value-based, virtual health care models to address issues such as access to specialists, healthcare speed and efficiency, and healthcare inequities. Indeed, approximately 75 percent of employers in a recent survey said they plan to ramp up their implementation…

Paying it Forward: How Payers Can Accelerate the Transition to Value-based Care

September 8, 2021Garrett SchmittNo Commentscost of care, Medicaid, Medicare, medtech, Payers, value-based care, vbc

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….

10 issues every healthcare leader should be thinking about

September 3, 2021Garrett SchmittNo Commentsautomation, care delivery, cost-effectiveness, COVID-19, cyber security, digital enablement, health analytics, health insights, health insurace, health IT, healthcare, healthcare IT, healthcare leaders, information security, Interoperability, IT effectiveness, IT performance, metrics, pandemic, Payers, post-pandemic, Reimbursement, staffing

As the toll of the pandemic has continued to be evident, many are contemplating what lasting changes healthcare providers and health systems may face at the end of pandemic. But what should healthcare leaders be thinking about now to prepare their organizations for the post-pandemic environment. Staffing Review your strategy for recruiting and retaining key…

How Payers Can Support Population-Based Payment Model Uptake

July 14, 2021Garrett SchmittNo Commentsadvanced payment models, APMs, Payers, population-based payment models, Telehealth, virtual care

As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately for health insurers, the healthcare industry has lagged in population-based payment uptake. Population-based payment models are models that are detached from fee-for-service reimbursement altogether, as opposed to other alternative…

Going Beyond Compliance: How Payers Can Embrace Healthcare Interoperability

June 28, 2021Garrett SchmittNo CommentsCAQH, CMS, compliance, consumers, Data, decentralized database, health information exchange, HHS, Interoperability, ONC, Payers

Payers may be prepared to comply with the interoperability rule for the July 1 deadline, but are they ready to adopt healthcare interoperability long-term? For the past couple of years, CMS has pushed the industry to take bigger steps toward standardizing interoperability. “CMS continues to build on its roadmap to improve interoperability and health information…

Why should payers and employers care about community care networks?

June 9, 2021Garrett SchmittNo CommentsCBOs, CCNs, community care networks, DEI, holistic, Payers, precision health, Precision Medicine, SDOH, value-based benefits administration, VBBA, vbc

There’s a growing awareness among employers, community advocates, and the public health sector that issues of diversity, equity, and inclusion (DEI) must be addressed in the healthcare ecosystem if we are to implement genuine value-based care (VBC). Unlike traditional fee-for-service healthcare, VBC emphasizes keeping people well over “sick care.” As a holistic approach to healthcare,…

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