During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…
Value-based care (VBC) is a crucial step towards improving access, equity, and quality healthcare for Americans. Since the inception of Blue Cross Blue Shield in the 1930s, the US healthcare system has relied primarily on fee-for-service (FFS) payment practices. Essentially, you go to the doctor for a specific need, the doctor serves that specific need,…
The healthcare industry is in the throes of unprecedented change as hospitals, providers, and payors all grapple with new methods of delivering (and billing) medical care. The uptick of value-based care, coupled with the growing prevalence of alternative therapies, makes understanding this new model a must. So, what exactly is value-based care? And why is…
Hospice providers are increasingly turning to data analytics systems to gain an edge against competitors when engaging prospective referral partners, anticipating impacts in value-based care. Data are key to demonstrating the value of hospice to potential referral partners as evolving value-based payment models take effect. The value-based insurance design demonstration project, commonly called the Medicare…
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…
While I am a practicing clinician, I am a firm believer that improvements in healthcare most often come from borrowing the best ideas from other business models. For example, I have sometimes borrowed from software company and payer colleague insights to describe value-based care (VBC) reimbursement as a subscription model. This model would provide more…
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…
There’s a growing awareness among employers, community advocates, and the public health sector that issues of diversity, equity, and inclusion (DEI) must be addressed in the healthcare ecosystem if we are to implement genuine value-based care (VBC). Unlike traditional fee-for-service healthcare, VBC emphasizes keeping people well over “sick care.” As a holistic approach to healthcare,…
Sustainable health care systems should be focused on outcomes instead of reimbursing for the services provided. Critical levers for accelerating this are patient engagement and a more comprehensive, standardized collection of patient outcomes. Also, more expertise is required on how these data can best be incorporated into the care process. The Innovative Medicines Initiative project,…
Roughly $4 trillion is spent on healthcare annually in the U.S. Despite this massive expenditure, roughly 80% of health outcomes are attributed to social, behavioral and environmental factors, known as social determinants of health (SDOH). What has been far less clear is how providers and payers can fully harness SDOH data to proactively manage the…