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,…
The Triple Aim. The Quadruple Aim. Right care at the right place at the right time. Whether one works in a hospital or small independent practice, healthcare providers are leaning on these concepts to deliver valuable care to their patients, and that is in its simplest form: care that results in the best patient outcomes…
High-quality primary care implementation requires significant healthcare payment reform, expanded telehealth capabilities, and team-based care, according to a recent report from the National Academies of Sciences, Engineering, and Medicine. According to the report, 85 deaths per day are associated with the declining workforce in primary care. Compensation in primary care is typically lower than that of specialty…
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…
Accountable Care Organizations (ACOs) have been a hot topic in the industry since the first ACO appeared on the scene in 2010, expanding from their roots in Medicare to the commercial space, and now frequently serving as a vehicle to align employers, health plans, and providers. According to an Oliver Wyman survey, ACOs in 2015…
Value-based care has resulted in medical cost savings, investments from commercial lines of business and an accelerated decline in fee-for-service, according to a Change Healthcare national research study. The study, conducted by ORC International in April and commissioned by Change Healthcare, included a survey of 120 managed Medicare, managed Medicaid and commercially focused payers. Here…
Successful value-based care initiatives require payers to learn which populations experience a high prevalence of chronic disease, where their organizations overspend, and how value-based contracting can solve these problems. Carefully assessing value-based care opportunities, implementing analytics strategies that can accurately identify opportunities, and monitoring success with meaningful quality measures can help payers achieve higher quality…
High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans. In addition to the stand-alone goal of leaving members with a satisfactory experience, the quality of customer relations is included in NCQA’s HEDIS measures, one of the most…
Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries. But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries requires a great deal of strategy and insight. The BlueCross Blue Shield Association (BCBSA) has successfully scaled its value-based care initiatives through the Blue Distinction…
Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety of Medicare Advantage plans with more variation of health benefits, specialized cost-sharing designs, and…