It has been clear for years that social determinants of health (SDOH) – factors such as education, economic and housing stability, community support, and access to transportation – have a disproportionate impact on health outcomes. Research shows that SDOH accounts for up to 80% of health outcomes, while medical care – which costs the U.S….
The first step in qualifying to meet the requirements of a value-based Stark exception or a valuebased Anti-Kickback Statute safe harbor is that the parties establish a “value-based enterprise.” The concept of a value-based enterprise is very definitionally driven, so before attempting to create a value-based enterprise it is imperative to fully understand the regulatory…
Industry expert David Smith, Founder and CEO of Third Horizon Strategies, provides an overview of CMS’s value-based initiatives with specific perspectives on the new administration’s Medicare/Medicaid philosophy, the rise of complex care management, and Medicaid Advanced Payment Models. He also shares an update on the core CMS payment models including MIPS, ACOs, and BPCI, as…
In November of 2020 the Centers for Medicare & Medicaid Services (“CMS”) finalized value- based exceptions under the Stark Law and the Office of Inspector General (“OIG”) finalized value- based safe harbors under the Anti-Kickback Statute, in an effort to accommodate and facilitate the evolution of value-based care arrangements among health care providers. “Value-based care”…
Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many…
A robust hospice mergers and acquisitions market is showing no signs of slumping as interest among strategic buyers and private equity investors ramps up. A provider’s performance within evolving value-based payment models may become a factor that potential buyers consider when eyeing a hospice acquisition, particularly as it pertains to their quality and outcomes data….
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…
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,…
The healthcare system is at a critical point in its transition to value-based care a decade after implementation of the Affordable Care Act and its Center for Medicare and Medicaid Innovation (CMMI), according to CMMI’s newly minted director Liz Fowler, PhD, JD. “The goal [of the ACA] was to create a system that rewards better…
The Center for Medicare & Medicaid Innovation (CMMI) remains committed to moving the health care system towards value-based care in the early years of the Biden Administration, though the center’s leadership is doing some soul-searching on how best to pursue its mission, according to CMMI’s new director Liz Fowler. Fowler made her first public remarks…