The role of homecare providers is central as the industry transitions to value-based care. Rather than reimbursing providers based on the quantity of services delivered, value-based care rewards providers for the quality of their services and their impact on member outcomes. However, when considering factors that impact the health of a member receiving care in…
As the United States continues to move toward value-based care, a great deal of attention has been given to vulnerable patient populations. Patients with higher needs (and correspondingly higher costs) are among those who would benefit most from healthcare improvement efforts, but those costs can represent significant risk to networks that stake their revenue on…
The COVID-19 pandemic has taught us it’s possible for the health care system to transform care delivery—and quickly. We saw vaccines come to market in record time, heightened cross-industry collaboration to track vaccine statuses, and virtual care use surge. Similarly, the pandemic demonstrated that value-based care delivery models, where payment is based on outcomes versus the…
Loneliness and social isolation rose alarmingly during the COVID-19 pandemic as lockdowns proliferated and in-person gatherings were discouraged. A critical social determinant of health (SDOH), social isolation is estimated to have increased by 6.7 percentage points during the pandemic. To help combat this and other SDOH issues, providers and payers are turning to data analytics. Several companies have…
In an attempt to curb rising costs, the U.S. medical system is moving away from traditional fee-for-service healthcare. Traditional fee-for-service and volume-based healthcare models pay providers for the amount of healthcare services they provide, not the quality of that care. Value-based care is the new model: a system in which providers are paid for performance and patient…
The question of whether ACOs should be forced to accept “downside risk” — in effect pay a penalty if they exceed certain spending benchmarks — has bedeviled CMS’ ACO programs and ACO programs in general. Seema Verma, the Trump administration’s CMS director, pushed for more downside risk, and the administration’s Pathway to Success program shortened…
For better chronic disease management, Boston University researchers recommend replacing the term “race” with underlying factors that indicate an increased risk for heart attacks and strokes. “If other factors (instead of race itself) determine the risk differences, then the prediction equations should incorporate those factors that cause the differences in predicted risk between the races, rather than race itself….
The Medicare Shared Savings Program, the accountable care organization (ACO) model that served 10.6 million seniors in 2020, collectively saved Medicare $4.1 billion last year, and $1.9 billion after accounting for shared savings payments, according to the National Association of ACOs and as recently published in Healthcare Finance. 513 ACOs participated in the Shared Savings Program in 2020, down…
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…
At the beginning of this series, we laid out a basic tenet: As shared savings plan ACOs, you need to do as well or better at lowering costs than competing value-based payment models. Otherwise, your resources and support will dwindle in favor of more promising avenues to control Medicare spending, and competition will stifle your…