Building Payer-Provider Partnerships for Bundled Payment Models
A bundled payment model born from a payer-provider partnership between Blue Cross Blue Shield Rhode Island (BCBSRI) and University Orthopedics has helped deliver a holistic, outpatient delivery of a...Value-Based Care Assessment Calls for Payer-Provider Collaboration
The healthcare industry is moving away from fee-for-service reimbursement. Healthcare professionals recognize that this payment structure is fraught with misuse and overuse, incentivizing providers to...National Hepatitis C Screening Rate Low Despite Widespread Need
The U.S. Preventive Services Task Force (USPSTF) has made a B-level recommendation that all young adults and adolescents should be screened for hepatitis C, which has become more prevalent in the wake...Implementing Value-Based Reimbursement in Behavioral Healthcare
Residents of western New York will have access to the region’s first behavioral healthcare provider group with a value-based reimbursement arrangement, BlueCross BlueShield of Western New York...Opposite Opinions on Cost of Care End Payer-Provider Contracts
Two major payers were unable to seal their deals by the first day of the new year due to conflict over the appropriate cost of care. UnitedHealthcare and Houston Methodist have ended their...BCBS MI, Provider Orgs Sign Risk-Sharing, Value-Based Contracts
Blue Cross Blue Shield Michigan (Blue Cross) is initiating value-based contracts with seven major Michigan healthcare providers under their alternative payment model called the “Blueprint for...Value-Based Reimbursements Hit 53% in 2017, Reform Slows
Update 1/7/2020: This article was updated to reflect that half of the reimbursements in the commercial sector made in 2017 were value-based. Previously, the first line of the article stated that half...UPMC Value-Based Drug Contract Hinges On Disability Progression
UPMC Health Plan has entered into a value-based agreement with pharmaceutical manufacturer Biogen to be reimbursed for multiple sclerosis medications on the basis of disability...CMS Finalizes Home Health PPS, Expands Infusion Medicare Benefits
CMS has announced the finalization of changes to the home health payment model, known as the home health prospective payment system (HH PPS), which includes a home infusion benefit and offers an...New Executive Order Pledges Increased Support for Medicare Advantage
On Thursday, President Trump issued the Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors that will authorize the Department of Health & Human Services to expand...Humana Expands Bundled Payment Models for Spinal, Joint Surgeries
Humana recently expanded its value-based payment models by signing four more agreements with providers for bundled payment models for spinal fusion surgeries. The payer also announced the growth of...CMS Proposes Alternative Payment Models for Chronic Kidney Disease
CMS recently proposed five alternative payment models for chronic kidney disease (CKD) treatments. One model is mandatory and the others are optional. All of the models are in response to the...Sponsored Article
