Everybody’s Talking About Value-Based Health Care. Here’s What They’re Not Saying.

April 12, 2022acoHospitals, Specialists, value-based care, vbc

Attend any healthcare conference and you’ll quickly discover that it’s become downright fashionable for healthcare leaders to talk about their unwavering commitment to “value-based care.” The expression has become ubiquitous in healthcare circles. Its virtuousness goes unchallenged. But should that be the case? Michael E. Porter and Elizabeth Teisberg (with whom I worked as a…

Specialists are Testing the Value-based Care Waters

July 21, 2021Garrett SchmittNo Commentshealthcare technology, Specialists, value-based care, vbc

Specialists are key partners for delivering value-based care, particularly for patients with chronic diseases. This involves the appropriate diagnosis of conditions, including rare diseases, stewardship of diagnostics and value-based prescribing for specialty medications. Lawrence Kosinski, M.D., MBA, founder and chief medical officer of SonarMD, a tech-enabled care coordination solution for digestive health, notes the great…

The expanding role of specialists in value-based care

June 13, 2021Garrett SchmittNo CommentsACOs, Bundled Payments, Specialists, vbc

Value-based care has become a buzzword over the past decade with early experiments in Massachusetts, followed by creating Medicare accountable care organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments. Much of…

How value-based care helped our independent practice survive 2020

April 26, 2021Garrett SchmittNo CommentsCollaboration, COVID-19, independent practice, quality care, Shared Savings, Specialists, Telehealth, vbc, virtual care

When the COVID-19 pandemic began to disrupt daily life in the U.S., many medical practices were left scrambling. Patient volumes plunged immediately, non-urgent care was postponed, and no one was sure exactly how long the shutdowns and mitigation precautions would last. By late April, 97% of practices reported a negative financial impact from the pandemic,…

Balancing Specialty and Primary Care Lowers Costs for ACOs

July 31, 2019Garrett SchmittNo CommentsSpecialist, Specialists

Accountable care organizations (ACOs) that provided between 40 and 45 percent of office visits through specialists had significantly lower costs compared to ACOs with the lowest and highest specialty care proportions, according to a recent University of Massachusetts Amherst study. Published in JAMA Open Network, the study of 620 ACOs in the Medicare Shared Savings Program…

Fitting Specialty Care Into ACOs

November 20, 2018Garrett SchmittNo CommentsSpecialist, Specialists

The footprint of accountable care organizations (ACO) continues to change. At the start of 2018, there are approximately 1,000 ACOs covering 32.7 million consumers—approximately 11% of the U.S. insured population (294.6 million)—under 1,477 different contracts (see After A Slow 2017, ACOs Grow & Expand Their Contracts In 2018). The coverage varies by payer. According to…

Five Strategies for Specialists: How to Safely Navigate ACO Arrangements

September 26, 2018Garrett SchmittNo CommentsSpecialist, Specialists

Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also…

Create Value for Consumers by Leveraging ACO Provider Choice

July 11, 2018Garrett SchmittNo Commentscare coordination, patient experience, Referrals, Specialists

Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking…

ACOs and Specialty Physicians: How Episodes of Care Create a Win-Win Cost and Quality Strategy

May 9, 2018Garrett SchmittNo CommentsEpisodes of Care, Specialist, Specialists

Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about…

Recent Posts

  • First Look at Open CMMI Model Data: Value-based Care Growth Drivers in 2022
  • RECORDED WEBINAR: Leveraging Expected CMS Payments for a Working Capital Loan
  • What Prescription Drug Pricing Can Learn From Value-Based Care Models
  • Value-based care services plant roots in the evolving healthcare landscape
  • CMS releases three initiatives to grow Medicare ACO participation
 
  • Main Lobby
  • Exhibit Hall
  • Events
  • Exhibit With Us
  • Board Room
  • Library
  • Contact Us