After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP….
CMS has made substantial progress on its goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030. As of January 2025, 53.4% of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider. This represents more than…
Generative artificial intelligence can identify social determinants of health within EHR notes, accurately and without bias, determining which patients might need extra support, according to Somerville, Mass.-based Mass General Brigham. The health system’s researchers fine-tuned large language models to automatically extract information about social determinants — factors such as housing, employment and family status that…
The Centers for Medicare & Medicaid Services (CMS) has approved New York state’s amendment of its ongoing Medicaid transformation efforts to allow the state to advance health equity, support the delivery of health-related social needs (HRSN) services, and promote workforce development. The state said the waiver would enable New York to invest nearly $6 billion…
Researchers from the University of South Carolina School of Medicine and Arnold School of Public Health recently conducted a study to determine what factors may interfere with patients completing SDoH screenings with their primary care providers. Though more and more health systems have recognized the impacts of nonclinical factors, such as food, housing, and transportation,…
The Centers for Medicare & Medicaid Services (CMS) introduced the Risk Adjustment Factor (RAF) model in 2004, which was designed to estimate future healthcare costs for patients. RAF scores are a critical component of value-based care, as they help predict healthcare resource utilization while adjusting for quality and costs for patients. With the introduction of the v28 HCC…
Patients who have had vascular surgeries are often readmitted to the hospital for a variety of reasons — often preventable — more often than patients who undergo different types of surgeries. These readmissions could be largely avoided if other aspects of the discharge process were improved, according to research led by the University of Missouri in Columbia….
The American Heart Association, a global force for longer, healthier lives for all, is advocating for a shift away from the current health care payment system in the U.S., which is primarily based on fee-for-service, to a value-based payment (VBP) system. A VBP system is person-centered, equitable, coordinated and seeks to improve outcomes and experiences…
Identifying and tackling social determinants of health (SDOH) are crucial aspects of any health equity strategy. But establishing how best to capture patients’ SDOH needs and develop interventions in the clinical setting remains a significant challenge for many healthcare organizations. The United States Department of Health and Human Services (HHS) defines SDOH as “the conditions in the…
The Biden administration rolled out three new payment models intended to lower drug costs, including new Medicare coverage options for drugs cleared under accelerated approval. The release of the three models on Tuesday is in response to an executive order President Biden delivered last year calling for the federal government to search for ways to…