Enacting value-based care payment models has been a priority of payer and provider organizations in recent years, but the implementation has been uneven, with care centers serving underprivileged or vulnerable populations being left in the lurch. Helping close the gap is pivotal to reaching the US Centers for Medicare and Medicaid Services (CMS) goal of transitioning to value-based payment models for the majority of Medicaid and Medicare reimbursements.
Value-based care models have been put forward as a solution for rising Medicare costs, paying providers for the value their care provides patients. New laws are further incentivizing adaptation of these payment models. To jump on board successfully, Edifecs published an article earlier this year covering three strategies to help providers take on value-based care models successfully.
Despite new rules in the US requiring providers to collect and report pricing transparency data, just over three quarters of hospitals are lagging behind. If this data can be accurately collected and analyzed, it could help establish fair value-based pricing models that could benefit both patients and providers. In addition, the law targets payer-related data.
The Association of American Medical Colleges (AAMC) released an issue brief that details the impact of Centers for Medicare and Medicaid Innovation (CMMI) value-based care on patient outcomes and healthcare costs. The AAMC notes that although these value-based care payment models have helped patients, better data collection practices are needed to advance health equity.
Fragmentation of care delivery systems results in patients falling through gaps in care, imperiling health outcomes and exacerbating health disparities. In a new Stat News article, Chris Dodd of the University of Washington School of Public Health and CMO of Emcara Health talks about how the Sea Mar Community Health Centers created an integrated approach to care that alleviated barriers to access for many patients.
Although value-based care models have become increasingly prevalent in recent years, they have yet to be implemented in several areas of care, including home medical equipment (HME). Speakers at a Medtrade panel session discussed the importance of moving to such models and what that entails for the HME industry.
The COVID-19 pandemic exposed deep disparities in care health outcomes in marginalized groups. One contributor to this problem are widely-used fee-for-service (FFS) payment models. In a new Forbes article, Rita Numerof argues that moving to a patient-centered value-based care model that accounts for social determinants of health (SDoH) is key to helping providers promote health equity through their care decisions.
Almost 30 provider groups have written a letter asking the US Centers for Medicare and Medicaid Services (CMS) to implement a hybrid system that mixes fee-for-service and prospective payments for primary care. According to the letter, doing so would incentivize primary care physicians (PCPs) to serve rural areas. The letter is, in part, in response to a push from the agency to get PCPs in rural and underserved areas to move to value-based care models.
Widespread healthcare workforce shortages and high employer-sponsored health insurance costs are impacting health systems and increasing healthcare costs. One potential solution for this problem is value-based care (VBC), which bases reimbursement on quality of care and patient outcomes. According to a new article in Benefits Pro, this can keep employees healthier and happier while reducing organizational health insurance costs.
Despite being largely onboard with value-based care models, oncologists speaking at the Association of Community Cancer Centers (ACCC) 2023 meeting were skeptical of the upcoming Enhancing Oncology Model (EOM) developed by the US Centers for Medicare and Medicaid Services (CMS). The EOM replaces the previous Oncology Care Model (OCM).
Although value-based payment (VBP) models offer the opportunity to advance health equity goals, doing so requires an intentional, carefully considered approach. Health equity must be centered in payment model design, according to newly published Health Affairs article in a recent series on VBPs. Patient attribution methods are critical but often overlooked.
A group of US healthcare organizations has asked Congress for several changes to help boost engagement in value-based care payment models as laid out in the the Medicare Access and CHIP Reauthorization Act (MACRA). The groups included the National Association of ACOs (NAACOS), the American Medical Group Association (MGMA), and the American College of Rheumatology (ACR). The program thresholds in the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) lay at the center of the organizations’ concerns.
While nearly 70% of primary care physicians have worked with some form of value-based care, a report by the Chartis Group has zeroed in on characteristics of PCPs that are driving the transition to this payment model. These “Leaders” in value-based care, who are involved in a partial- or full-risk capitation agreement, account for 21% of PCPs, according to the report.
The push towards value-based is changing the reimbursement landscape. However, this hasn’t meant there’s an increase in access to NHS patients in the UK. Instead, novel therapeutics are still out of reach for many. In a new PM Live article, Toby Gunner of Nzyme group describes the disconnect between patient access and reimbursement status.
Federally qualified health centers (FQHCs) are key providers of healthcare to the under- and uninsured population. In a new article in Health Affairs Forefront, Amanda Pears Kelly explains how FQHCs are a model of value-based care (VBC) that may serve as a model for the Biden administration’s push for the payment model and health Equity.
The US spends more than any other nation on healthcare, yet falls behind in many different measures of health outcomes, such as life expectancy, preventable hospitalization, and avoidable deaths. Value-based care has been presented as a way forward, replacing the current fee-for-service model that negatively impacts patients and clinicians. In a new article, Jacqueline LaPointe of Xtelligent Media speaks about the four key areas to work on to advance value-based carea.
Accountable care organizations (ACOs) are a key piece in establishing value-based care modalities that improve health outcomes and keep costs down. Although the COVID-19 pandemic reduced the total savings of these programs, value-based care saved Medicare $3.6 billion before shared savings payments were factored in. This figure was actually less than that of 2020.
Value-based care has been offered as a solution to minimize healthcare costs for patients and payers while providing the best possible health outcomes. In a new interview with Skilled Nursing News, Dr. Ben Zaniello, CFO of PointClickCare talks about the challenges and benefits of value-based care. One setback for value-based care is the relative paucity of providers that use the reimbursement model.
As the US moves towards value-based reimbursement for Medicare and Medicaid, uncertainty surrounds the logistics of such contracts. In a new article, Lavonna Bowman of Inovalon discusses the biggest questions surrounding value-based care. The first key step to improving health outcomes for patients is to clearly define the goals the care system is trying to reach.
Many healthcare organizations are supporting their value-based care decision-making and research with data analytics powered by artificial intelligence (AI) and machine learning (ML). However, for these tools to help address issues of health equity, the bias in the datasets used by AI must be addressed.