News & Studies
- National healthcare expenditures will increase to $5.7 trillion by 2026, growing at a rate of 5.5 percent each year.
- By 2026, healthcare spending will represent 19.7 percent of our nation’s economy.
- The Healthcare Transformation Task Force’s payer & provider members have made a commitment to have 75% of their respective businesses in value based payment arrangements by 2020.
- The adoption of value based care is expected to account for 59 percent of healthcare payments by 2020.
August 6, 2020
In the study, Chaiyachati and co-authors aim to evaluate the impact of the Community-Based Care Management program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization.
August 5, 2020
With patients hesitant about care access, they are demonstrating interest in self-management, which could help providers transition to value-based care.
July 31, 2020
As states weather the economic hits from the coronavirus pandemic, some are setting their sights on Medicaid, in particular the rates paid to private managed care providers.
July 27, 2020
With Medicare Part B now covering all COVID-19 testing costs, and CMS also waving Medicare participation conditions, the system could come to a breaking point in a matter of years.
July 27, 2020
As more payers move to VBP models, the relationship between the two parties will continue to be adversarial. Will it be less combative with more transparency?
July 26, 2020
Home health providers that received more than $10,000 from the Provider Relief Fund will need to account for all of the grant funds they spent by Feb. 15 at the latest, the U.S. HHS announced earlier this week.
July 26, 2020
Over the years, home care providers that have provided specialized care have positioned themselves to stand out among their competitors.
July 20, 2020
L.A. Care is supporting its safety-net providers during the pandemic through early payouts of value-based contracts and close partnerships with frontline workers.
July 15, 2020
Blue Cross Blue Shield of Massachusetts is launching a new payment model for small practices that combines value-based care and support payments.
July 14, 2020
The association urged CMS to modify the Medicare Shared Savings Program to protect providers from increased costs during the pandemic and opposed the cancelation of the program’s 2021 application cycle.
July 14, 2020
On June 17, CMS issued a proposed rule to grant state Medicaid programs and other payers flexibility to enter value-based payment (VBP) arrangements with drug manufacturers.
July 13, 2020
Overall, 75% of home care agencies did not track readmission rates at all in 2019, according to recently released data from Idaho-based market research and education firm Home Care Pulse.
July 13, 2020
Leveraging hospitalists, identifying obstacles, and creating a clinical strategy are key strategies for transitioning to value-based hospital medicine.
July 10, 2020
Neither safety net nor non-safety net hospitals showed improvements in the four infections analyzed, including after VBC was implemented.
July 7, 2020
According to CMS, the healthcare industry must change its payment structure to promote the overall health of patients and create incentives for doctors to keep patients healthy.
July 5, 2020
There’s a widening value-based care gap between larger home health providers and smaller mom-and-pop shops.
July 2, 2020
A new crop of healthcare startups are trying to shake up the $260 billion primary care market. It’s an industry that’s ripe for disruption, according to Canaccord Genuity healthcare analyst.
June 30, 2020
The pandemic has “thrown a wrench” into CMS’s “planning about continuing toward value-based care,” says Kevin Conroy, CFO at CareMount Medical in New York.
June 30, 2020
While value-based contracting was expected to stall during the pandemic, some payers see value-based care models as a lifesaver for independent provider partners.
June 30, 2020
Farzad Mostashari, MD, CEO of Aledade, discusses why physician practices that have leaned into value-based care have weathered the COVID-19 pandemic successfully.
June 16, 2020
Here are tips to help your children navigate some of the complicated emotions they may be facing with going back to school.
May 29, 2020
Many businesses are looking to their insurance program providers to help them manage, minimize and mitigate potential and actual losses as they weave their way through the haze of uncertainty and maze of confusion during this unprecedented time.
May 29,2020
Organizations receiving fee-for-service (FFS) payments have seen their revenues decline precipitously. This lack of capital affects their ability to adapt and respond to the pandemic.
May 27, 2020
While taxing, a newfound resourcefulness is something that will help home care providers re-envision home care moving forward and create change even after the coronavirus ends.
May 26, 2020
Telehealth exploded amidst the COVID-19 pandemic. But disparities in reimbursement for audio-only telehealth visits may have downstream implications for Medicare Advantage members.
May 26,2020
Providers that can adjust their business operations accordingly and keep up with the sweeping regulatory changes will have a massive advantage moving forward.
May 22, 2020
Accountable care organizations (ACOs) are seeking answers from the Trump administration over the status of the Next Generation ACO Model set to expire this year and the upcoming Direct Contracting Model.
May 19, 2020
In light of the coronavirus pandemic, ACOs should have until at least Oct. 31, 2020, to voluntarily exit the Medicare Shared Savings Program, nine industry groups said.
May 19, 2020
Virtual healthcare visits have increased during the coronavirus pandemic, kicking off a trend that will extend past the crisis.
May 18, 2020
COVID Innovation: Amid the COVID-19 outbreak, post-acute care organizations have had to pivot. Built-in flexibilities allow PACE organizations to relatively easily shift care into the home
May 18, 2020
A new survey shows that APM participants were more likely to leverage care management support for managing the COVID-19 surge, including triage call centers and remote patient monitoring
May 18, 2020
Even after the immediate emergency of the current COVID-19 pandemic passes, the healthcare industry won’t return to business as usual, experts say.
May 17, 2020
After an immense disruption from the COVID-19 virus led to a dip in patient visits and revenue, home-based care insiders are now reporting budding signs of normalcy.
May 11, 2020
Citing hardships caused by COVID-19, some senators have asked the Defense Health Agency to expand telehealth coverage under TRICARE and filed a bill to expand the VA’s cadre of care providers able to use telehealth.
May 11, 2020
Pennsylvania’s plan to protect its nursing homes was robust and aggressive. But the plan was never fully implemented.
May 10, 2020
Federal agencies and experts are reporting increasing rates of mental health problems and predict that this is only the beginning of a lasting mental health crisis.
May 10, 2020
Millions of Americans who suffer from hearing and vision loss are struggling to access critical health-care services. The CDC and WHO are trying to make information available to them.
May 7, 2020
Amidst the pandemic, more than 1 in 4 American adults met the criteria that psychologists use to diagnose serious mental distress and illness.
May 6, 2020
The COVID-19 pandemic is intensifying inequalities experienced by the world’s one billion people with disabilities.
May 5, 2020
Humana CEO Bruce Broussard said Tuesday that he expects telehealth and other changes embraced by the health-care sector during the coronavirus pandemic to have a lasting impact on how people go to the doctor.
May 5, 2020
A federal government waiver, issued early in March, expanded the use of federally funded health insurance — Medicaid, Medicare and the Children’s Health Insurance Program — to pay for telemedicine visits.
May 1, 2020
The risk of mental health problems increased during COVID-19. For many, especially young people, the online world can be a positive link to others in a similar situation or predicament.
May 1, 2020
Faced with insufficient hospital beds, medical equipment and personnel, normally slow-moving healthcare systems have improvised and innovated in response to the COVID-19 pandemic.
April 28, 2020
The Centers for Medicare & Medicaid Services (CMS) released guidance on March 17 that allows Medicare to pay for telehealth services provided across the country.
April 27, 2020
Demand for telehealth systems has boomed in response to the ongoing COVID-19 pandemic, setting the stage for telemedicine to finally achieve some of its long-promised benefits.
April 26, 2020
Home care agencies navigating financial headwinds associated with the COVID-19 virus can seek relief through the Paycheck Protection Program (PPP).
April 24, 2020
With American facing unforeseen obstacles and concerned about their futures, more than 60 million Americans with disabilities like her are facing perhaps the toughest road of all.
April 16, 2020
As the coronavirus continues to spread across the U.S., one might assume the home-based care industry is booming, due to providers’ special ability to keep vulnerable senior populations safely at home
April 15, 2020
The protocol for arranging telemedicine sessions varies by location, by practice specialty and by your ongoing history with a physician. Here are some common steps and tips to prepare for such a virtual visit.
April 14, 2020
Fifty-six percent of healthcare organizations that take on financial risk in Medicare Shared Savings Program contracts are likely to drop out of the program, according to a new survey from the National Association of ACOs.
April 14, 2020
As COVID-19 continues to upend care patterns and utilization, at-risk ACOs weigh exiting the MSSP and NextGen Model before they must repay CMS shared losses.
April 8, 2020
With U.S. public health experts warning of a cresting wave of coronavirus infections in the coming weeks, rates of transmission among the nation’s front-line fighters — doctors, nurses and other medical staff — are setting off alarm bells.
April 8, 2020
Although the burden of providing direct care and treatment of COVID-19 patients is falling on hospitals and other providers, payers will be bearing the costs of that care.
April 6, 2020
The coronavirus disease 2019 (COVID-19) pandemic will exacerbate the financial situations of the millions of Americans who struggle to afford their medical care, but policy solutions are available to quickly mitigate this problem.
April 1, 2020
With U.S. public health experts warning of a cresting wave of coronavirus infections in the coming weeks, rates of transmission among the nation’s front-line fighters — doctors, nurses and other medical staff — are setting off alarm bells.
April 1, 2020
Doctors in Italy who have seen COVID-19 decimate their hospitals issued a plea to American health care providers this week: care for people at home.
April 1, 2020
A new report warns of rising premiums and out-of-pocket expenses for beneficiaries resulting from healthcare spending to combat the global COVID-19 pandemic.
March 30, 2020
Multiple managed care plans have made changes to their procedures for admissions to the skilled nursing setting amid the ongoing coronavirus pandemic, with several major companies suspending prior authorization requirements for admissions to a skilled nursing facility.
March 27, 2020
An already tight timeline for complying with the CMS’ new interoperability regulations could put a strain on insurers as they tackle the COVID-19 outbreak.
March 27, 2020
The House passed a $2 trillion stimulus package Friday, clearing one of the last major hurdles for the emergency bill set to aid companies and individuals during COVID-19.
March 21, 2020
Marion Austin used to visit her husband John Austin every day at a nursing home in Rutland, Vt. Now, the couple of 70 years is keeping in touch via FaceTime.
March 17, 2020
The CMS on Tuesday approved Florida’s 1135 Medicaid waiver request, waiving specific Medicaid requirements to accelerate access to critical services in the fight against COVID-19.
March 13, 2020
Nursing facilities provide care to populations with those characteristics, and residents in these facilities are at risk of developing serious illness or dying if infected.
March 12, 2020
In a letter submitted to the U.S. CMS , the NAHC urged regulators to make sweeping changes that would free up home health providers in their fight against COVID-19.
March 12, 2020
Over the past two weeks, home health providers and industry advocates have expressed serious concern about over-capacity issues the COVID-19 pandemic may cause.
March 11, 2020
As new coronavirus infections accumulate across America, hospitals want to make sure they have everything they need to keep staff safe.
March 11, 2020
We spoke with infectious disease and geriatric-care specialists about the steps that can be taken to keep older people healthy in the face of coronavirus.
March 11, 2020
Confusion about how to address the novel coronavirus helped speed the spread to nearly a dozen long-term care facilities at the epicenter of the U.S. outbreak
March 4, 2020
COVID-19 — the viral disease more commonly known as the coronavirus — is spreading. The home health care industry has also started to prepare for possible disruption.
March 9, 2020
Value-based care initiatives account for only a quarter of hospitals’ revenue, according to a recent survey of healthcare executives.
February 28, 2020
ACOs were developed to push the healthcare industry toward VBP. But the model is not the final solution, industry experts say.
February 27, 2020
States and Medicaid managed care organizations are experimenting with value-based payment models, but their policy choices come with difficult tradeoffs.
February 18, 2020
Decreasing the percentage of primary care delivered out-of-network across all ACOs by 0.1% could save Medicare $45M a year.
February 17, 2020
ACOs were developed to push the healthcare industry toward VBP. But the model is not the final solution, industry experts say.
February 14, 2020
Accountable care organizations play a critical role moving the care continuum toward value. But such complex contracting options make it challenging for ACOs to achieve success.
February 12, 2020
When it comes to adopting value-based care and developing a consumer strategy, providers are significantly further behind compared to payers, according to the tenth annual Industry Pulse Report from Change Healthcare and the HealthCare Executive Group.
February 10, 2020
Implementing advanced primary care models in a fee-for-service world is nearly impossible. A shift towards more holistic, patient-centered primary care requires health systems move towards value-based contracts.
February 10, 2020
Be it consumerism or interoperability, payers and providers are not seeing eye to eye. And when it comes to value-based care, there is an even bigger disconnect between the two according to the results of a new survey.
January 30, 2020
Borrowing from Amazon, Facebook, and LinkedIn, an accountable care organization in Texas leveraged a HIPAA-compliant communications platform to improve care coordination.
January 23, 2020
Healthcare executives agreed in a recent survey that data analytics and technology are key to value-based care success, but most organizations do not have the health IT infrastructure.
January 22, 2020
Managed care can survive and may even thrive, experts say. But that will be in a world where public payers loom larger, provider prices are pushed down, the wellsprings of illness are addressed, and consumers aren’t quite so frustrated and angry.
January 17, 2020
The healthcare industry has learned a lot from the past 10 years of payment reform for value-based care. Experts explore what the future holds for alternative payment models.
January 11, 2020
A group of senior healthcare leaders recently discussed the transformation from volume-based care to value-based care. This transition represents a huge change in incentives for health systems.
January 4, 2020
Primarily aimed at improving care quality and reducing costs, value-based payment programs have downstream effects on both care and business processes that can reduce administrative waste for payers and everyone they work with in delivering and financing care.
November 27, 2019
The AMA is dedicated to driving medicine toward a more equitable future, removing obstacles that interfere with patient care and confronting the nation’s greatest public health crises.
May 23, 2019
Physician groups are moving, albeit slowly, to value-based payment, but there are still many obstacles standing in their way.
April 30, 2019
From Chris Smedley
Vice President of Physician Enterprise
Premier Inc., comprehensive, personalized care focused on long-term patient needs is key to success.
December 16, 2018
Condition-specific screening rates and cancer screening rates were higher among Humana Medicare Advantage members attributed to physicians participating in Humana VBC.
December 13, 2018
Twenty leaders in the health IT space discuss the key trends of 2018 and make predictions looking ahead to healthcare in 2019.
October 24, 2018
Value based care is on the rise, and statistics are trickling in that detail to what extent this is true. Case in point is a new report from the Health Care Payment Learning and Action Network, a part of the U.S. Department of Health and Human Services.
October 22, 2018
The percentage of healthcare payments linked to an alternative payment model increased five percentage points from 2015 to 2017. The shift away from fee-for-service is continuing at a steady pace, payment data revealed.
October 11, 2018
Alternative payment models (APMs) provide incentives for health care providers to deliver efficient, coordinated care centered on the needs of each patient rather than simply paying for the number of services delivered.
October 9, 2018
Nearly 1,300 providers have signed on to participate in Medicare’s newest at-risk bundled payment initiative, the Centers for Medicare & Medicaid Services announced Tuesday.
July 17, 2018
We examine the evidence behind shared savings—a payment arrangement often used between payers and accountable care organizations (ACOs).
June 18, 2018
As insurance companies shift more reimbursement away from fee-for-service medicine, doctors and their practices are seeing more of their bonuses and pay hikes based on “value-based metrics.”
May 30, 2018
BCBSA recently announced that since implementing its Blue Distinction Total Care program, it outperformed 96% of industry measures in key health care quality & consumer health metrics.
April 2, 2018
The Medicare Shared Savings Program (MSSP) was created by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA) of 2010.
March 8, 2018
Despite higher spending, the U.S. consistently reports lower life expectancies and overall poorer health outcomes than other developed nations. With our spending showing no sign of tapering off, something must change.
March 1, 2018
Pay for Performance in healthcare (P4P), also known as value-based payment, comprises payment models that attach financial incentives and disincentives to provider performance.
February 28, 2018
Bundled payments represent one form of alternative payment models (APMs) that are designed to move toward value-based care.
February 15, 2018
In a nutshell, survey results revealed that VBR is gaining momentum, slowly but surely.
February 2018
Placing greater emphasis on value in health
care is proving successful for everyone who
touches the health care system, including
consumers, care providers, and all types of plan
sponsors, from private employers to state and
federal programs.
September 25, 2017
Doctors and hospitals in the clutches of a flawed FFS payment model have grown dependent on providing more and more healthcare services, regardless of whether the additional care adds value.
July 20, 2017
The top challenges of healthcare bundled payments include achieving scale, leveraging post-acute care resources, and managing uncontrollable costs.
June 19, 2017
While participation in Medicare accountable care organizations (ACOs) continues to grow controversy swirls around their impact as analysts disagree about the success of the payment model.
March 10, 2017
This Issue Brief, analyzes the program’s impact on Medicare patients and hospitals, examines the decline in national readmission rates, and discusses implementation issues that policymakers have raised.
July 7, 2016
In theory, paying for performance makes logical sense, says Ashish Jha, MD, MPH, director of Harvard’s Global Health Institute. But eliminating pay-for performance programs isn’t the answer, he says. Instead, an overhaul is necessary.
February 2016
According to the Kaiser Family Foundation, Medicare Advantage—through which providers accept full risk to treat patients for a fixed annual rate—grew by more than 1 million beneficiaries from March 2014 – March 2015.
August 2015
Concerns about the impact of healthcare costs on the economy and the exploration of new reimbursement models have colluded to encourage a transition “from volume to value” in US healthcare.
April 27, 2014
Federal policies to reward high-quality health care are unfairly penalizing doctors and hospitals that treat large numbers of poor people, according to a new report commissioned by the Obama administration that recommends changes in payment policy.