Value-based Reimbursement

Value-Based Payment Adoption Drives 5.6% Reduction in Care Costs

by Thomas Beaton

Payers that implemented value-based payment models reduced healthcare costs by an average of 5.6 percent, improved provider collaboration, and created more impactful member engagement, according to a...

Helping Payers Implement Value-Based Hospital Reimbursement

by Thomas Beaton

Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control...

Medicare Bundled Payment Programs Primed to Produce Savings

by Thomas Beaton

Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from...

MSSP ACOs Taking on Downside Risk See Smaller Savings

by Thomas Beaton

Medicare Shared Savings Program (MSSP) ACOs that take on downside risk generate smaller savings than upside risk ACOs, according a Center for Healthcare Quality and Payment Reform (CHQPR) analysis. In...

Preventing Provider Fraud through Health IT, Data Analytics

by Thomas Beaton

Healthcare fraud is an industry-wide problem can impact a payer’s ability to protect their revenue streams and maintain financial integrity. Fraud costs the nation’s healthcare payers...

Assessing Providers for Participation in Value-Based Care Contracts

by Thomas Beaton

Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones...

Verma: Patient Care, Payment Design Need Value-Based Reforms

by Thomas Beaton

Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the...

How Payers Can Effectively Scale Value-Based Care Networks

by Thomas Beaton

Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement...

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare...

CMS Value-Based Payment Programs Show Satisfactory Performance

by Thomas Beaton

CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate...

CMS Rule Ups Medicare Hospital Payments, Cuts Quality Measures

by Thomas Beaton

CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

by Thomas Beaton

CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider...

Humana Launches Bundled Payment Model for Maternity Care

by Thomas Beaton

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles...

Bundled Payments Require Clinical Insights, Provider Buy-In

by Thomas Beaton

Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential...

Health Plan Variety Does Not Boost Managed Medicaid Performance

by Thomas Beaton

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in...

AMA Promotes Alternative Payment Model for Opioid-Use Disorder

by Thomas Beaton

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have announced plans to promote an alternative payment model to address opioid use disorder. Leaders at...

Humana Expands Bundled Payment Model for Medicare Advantage

by Thomas Beaton

Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic...

Health Plan Data Governance Assists Value-Based Reimbursement

by Thomas Beaton

Health plan data governance plays a key role in overcoming barriers related to industry-wide adoption of value-based reimbursement, according to a two-year study conducted by CAQH CORE.  Health...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

by Thomas Beaton

BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates...

Payers Enter New Value-Based Care Agreements with Providers

by Thomas Beaton

Commercial payers including Aetna, Cigna, and Tufts Health are launching new value-based care agreements with providers to reduce healthcare costs and increase care quality for beneficiaries. Many...