Primary care physicians (PCPs) and other physicians continue to migrate away from the traditional fee-for-service (FFS) reimbursement model toward value-based and risk-bearing care models that reward better outcomes and reduced healthcare costs. Value-based care (VBC) contracts are projected by McKinsey to cover nearly 65 million Americans, or 22% of insured lives, by 2025, up from…
In recent years, momentum among Accountable Care Organizations (ACOs) to improve health equity has increased. The Centers for Medicare & Medicaid Services’ announcement of the redesigned ACO REACH contracting model to improve health equity will only accelerate this momentum. In this blog, we will help ACOs and healthcare payers understand how healthcare analytics can be used to identify health equity challenges…
Appropriate Care: What’s the big deal? It is well known that the United States spends more than any other nation on healthcare, but as a nation, our health outcomes miss the mark. As evidence-based medicine evolves, it is important that our healthcare practices adapt. With burnout at an all-time high and staff shortages on the…
Doctors have long known that factors such as food insecurity, housing instability, transportation problems and financial problems can impact a patient’s health. Patients who are now returning to physicians’ offices and hospitals for routine checkups, deferred elective procedures, prescription refills and more are presenting with conditions made worse by lost jobs and the struggle to…
For 10 years, the agency that runs Medicare has offered doctors and their practices extra money if they joined groups called Accountable Care Organizations and improved the quality of care they provided to older patients covered by traditional Medicare, while also focusing on the cost of their care. But a new study finds that those…
What is a “quality” physician? Depending on the stakeholder, there will likely be a different answer. A clinician’s response would vary depending on their specialty, training, and practice setting. At the same time, a patient would place greater value in bedside manner and shared decision making. A payer might tell you it is a clinician…
Throughout the last decade of ACO development, many have struggled to identify what actually makes ACOs successful. Analyses have been fraught with conflicting conclusions. Studies have tagged type of ownership (hospital-based vs. physician-led), geographic region or urban-rural factors, primary-care-only versus specialty participation, ACO payment model type, patient volume, and operations strategies as links to success…
Several medical groups say a new round of cuts to Medicare payments set to go into effect in 2022 will derail their move to value-based care and impact hiring of new staff. Medical groups spoke about the need for Congress to avert a series of cuts during a briefing on Tuesday sponsored by the American…
ACOs have zealously protected their favored status under Medicare Value-Based payment models, ensuring enough time for organizations to feel comfortable with financial risk and make investments in infrastructure. But if your own ACO is losing physicians to new equity-financed networks or to hospitals consolidating practices, more time does not help you. Primary care physicians are…
Physician groups are calling the Medicare Physician Fee Schedule proposed rule a mixed bag for practices, which now face a potential reduction in physician reimbursement next year, among other changes. “The proposed 2022 Medicare Physician Fee Schedule (PFS) represents a mixed bag for physician practices,” Anders Gilberg, senior vice president of government affairs at the…