Health Affairs examined the characteristics of counties that experienced changes in insurers’ participation in the ACA Marketplaces from 2016 to 2021.
Humana released a report with details on three key areas of data—prevention, outcomes and utilization, and costs and payments—for Humana individual Medicare Advantage (MA) members seeking care from primary care physicians in value-based agreements.
Healthcare costs continue to be a barrier for seniors. In fact, over one in four seniors in America face high out-of-pocket costs and lack emergency funds to pay for healthcare services, according to a MedicareGuide.com survey
The 2019 Medicare Current Beneficiary Survey’s (MCBS) preliminary report was released with data on quality of care, access to care, and cost of care, among other topics.
Break Through Value Based Payments Part 10: Risk Capitation Pros and Cons THE VBP Blog Welcome back to THE VBP Blog Series. Continuing our drill-down into risk-sharing in Value Based Payments, in today’s blog we look at the capitation model. As the ever-challenging task of lowering healthcare costs continues to come to the forefront, organizations may look to capitation, which requires that providers take on the full financial risk for the care of their consumers. Do keep reading! It’s already shown success in California, where the state’s Regional Health Care Cost & Quality Atlas reveals the capitated-integrated model delivers on all the major VBP scores: 9% lower total cost of care, 14 points higher in quality, and $4,450 less in total cost of care… Read More »VBP Risk Capitation Pros and Cons
Break Through Value Based Payments Risk Sharing in Value Based Payments The VBP Blog Welcome back to THE VBP Blog Series. As many of you have asked for continuing the global view of Value Based Payments, in today’s blog we look at how contracting entities take part in risk sharing arrangements. This is usually an option for mature VBP organizations, with proven stable data tracks and clear quality-controlled processes. Risk sharing involves actually foregoing revenues if goals are not accomplished. It should not be approached lightly. Caption for Photo Risk Sharing and Reward A shared risk value-based model representing possibly the best of both of those worlds. Thought of as the “next-level” of value payment methods, risk-sharing is the ultimate opportunity for… Read More »VBP Risk Sharing
Break Through Value Based Payments Risk Capitation Pros and Cons The VBP Blog So, in preparing for our 8th installment of our blog series, it’s become evident that there’s a whole lot more than 10 portions of the topic to cover. The progress through the Value Based Payments journey has many more steps and stepping stones than the initial view most of us have. In the past two weeks, I had the opportunity to talk with a number of providers about an alternative payment structure and I found myself breaking down the process from alternative payments to shared savings into potentially 15 or more steps. As you read on…. Consider our Advocate’s Perspective and join us in making sure that our consumers’… Read More »Shared Savings in VBP
Break Through Value Based Payments Succeeding with Payment for Outcomes The VBP Blog Value Based Payments are leading us to focus on the outcomes we can deliver and to have providers share in the savings. However, the real success of payment for outcomes is in better health outcomes, longer periods without a need for higher-level care, and better quality of life for consumers. The Advocate’s Perspective in this blog focuses on the latter part of this statement. Focusing on Patient Outcomes Value Based Payments are leading us to focus on the outcomes we can deliver and to have providers share in the savings. However, the real success of payment for outcomes is in better health outcomes, longer periods without a… Read More »Succeeding with Payment for Outcomes
Break Through Value Based Payments Bundled Payments THE VBP Blog As we move Onward! Along the continuum of Value Based Payments, we examine Bundled Payments in this installment of our series. We have noted that some of these topics require more depth, so you may see our series expand to 12 or more…. This gives us the opportunity to share and advocate even more. Look for our Advocate Perspective below! Bundled payments are forecasted to account for 17% of payments by 2021, according to McKesson and ORC International. In the past two blogs, we have covered payment for process, alternative payment models, and payment for performance. All three of those set up building blocks for larger value-based payment changes. Bundled payments in… Read More »VBP Bundled Payments
Break Through Value Based Payments Payment for Performance THE VBP Blog We have received very positive response to this series and we continue to see the path of Value Based Payments as a progression, a journey from knowing what you do, how you do it and how well you do it, to capitalizing on the quality of what you share in the value of what you are delivering. Our Advocate’s Perspective is at the end of this blog… Make sure to check it out! The second step in the Value Based Continuum is Payment for Performance (P4P). Payment for performance takes the fee-for-service model and nudges it towards a value-based model. This is done by having metrics set and providers achieving, advancing, or exceeding… Read More »VBP Payment for Performance