In November 2021, the Centers for Medicare & Medicaid Services (CMS) announced a strategy to achieve near-universal participation in value-based payment models by 2030. Core to this strategy is the goal that every beneficiary should be in a clinical care relationship that has accountability for quality and total cost of care. Achieving this goal will…
Hospitals and health systems can implement value-based payment models to ensure preparedness for seasonal and pandemic capacity surges, according to industry experts. Hospitals experienced increased demand for tangible resources and staff during the COVID-19 pandemic, demand health systems typically only face during peak flu season. Unlike organizations in other industries, hospitals and health systems tend to lose…
Today, the Health Care Transformation Task Force released a new resource to assist health care payer and provider efforts to form successful Alternative Payment Model (APM) arrangements. The resource, titled BUILDING BETTER PARTNERSHIPS: A FACILITATION GUIDE FOR SUCCESSFUL VALUE BASED PAYMENT ARRANGEMENTS, combines fresh insights from Task Force members with existing tools and best practice summaries…
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…
COVID-19 necessitated widespread loosening of state and federal restrictions on and rapid expansion of telehealth. Now, as policy makers consider telehealth in the post-pandemic period, they must make decisions about payment parity—whether to continue reimbursing clinicians equivalent amounts for in-person and telehealth visits. Some argue that telehealth requires less clinical effort and fewer overhead costs…
Telemedicine use skyrocketed among primary care practices during the pandemic, specifically for those with a value-based payment model, according to a research letter published in JAMA Health Forum. Many patients were forced to delay primary care due to the pandemic, which resulted in significant revenue losses for primary care organizations. Telemedicine use naturally increased to make up for lost revenue…
Over the past decade, adoption of value-based payment (VBP) models has increased substantially. The Center for Medicare and Medicaid Innovation’s has launched multiple new models since its authorization, commercial payers have structured almost one-third of their payments as alternative payment models (APMs), and state Medicaid programs have increasingly included payment reforms in their waivers and…
Providing timely, high quality, patient care is no easy feat. In fact, as the healthcare industry continues the shift toward value based care, this job becomes more complex, with growing requirements to monitor the outcomes of both individual patients and the greater patient population into which they fall. The movement away from fee-for-service, however, doesn’t have to…
High-quality primary care implementation requires significant healthcare payment reform, expanded telehealth capabilities, and team-based care, according to a recent report from the National Academies of Sciences, Engineering, and Medicine. According to the report, 85 deaths per day are associated with the declining workforce in primary care. Compensation in primary care is typically lower than that of specialty…
Due to high magnitude and variation in spending on post-acute care, accountable care organizations (ACOs) are focusing on transforming management of hospital discharge through relationships with preferred skilled nursing facilities (SNFs). Using a mixed-methods design, we examined survey data from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs…