Interoperability in healthcare, it would seem, is at an important inflection point. Rules around data exchange have been around for years, and regulate what patient information gets shared between payers, providers and the patients themselves. There are also standards around how that information is shared, and the forms it can take. But the transition to…
Championed by government entities like the Centers for Medicare and Medicaid Services and the Department of Health & Human Services, value-based care is here to stay. Hospitals are increasingly participating in value-based programs—such as the Hospital Readmissions Reduction Program and Bundled Payments for Care Improvement—in an effort to improve care delivery and patient outcomes while…
The Center for Medicare and Medicaid Innovations (CMMI) recently announced the ACO Realizing Equity, Access, and Community Health (REACH) Model. The REACH Model will replace the Direct Contracting model starting on 1/1/23. ACO REACH retains the DC Model Global and Professional tracks and adds new requirements to advance equity, promote provider governance, and protect beneficiaries….
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…
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You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of The Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt The COVID-19 pandemic has provided…
As 2022 unfolds, it is becoming increasingly clear that health care is at a crossroads. Do we keep reacting to crisis after crisis, potentially undermining our ability to provide consistent patient care over time? Or do we start rethinking traditional care delivery models, so they become nimbler and more attuned to our patients’ needs—the clinical…
Despite incredible work by health care workers during the pandemic, consumer and patient trust and belief in the health care system is dangerously low. Why is this a big problem now? Because as pressure to implement Value-Based Care initiatives is intensifying and creating more financial pressure on your already-slim margins, your health system or ACO…
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…
Despite the growth in value-based payment arrangements from payers, health systems continue to pay physicians based on the volume of services they provide. A new study published in the journal JAMA Health Forum finds that volume-based compensation was the most common type of base pay for more than 80% of primary care physicians and for more…