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Value-Based Care News

Two-Sided Financial Risk Model Reduces Socioeconomic Disparities

February 13, 2017 - A two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. Disadvantaged patients receiving care under the Massachusetts-based Alternative Quality Contract (AQC) with Blue Cross Blue Shield saw a 1.2 percent higher rate of improvement on...


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State Medicaid Programs Invest in Accountable Care Organizations

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Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are 10 states that are managing Medicaid ACO programs...

Stakeholders Offer Key Principles for Alternative Payment Models

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More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and hindrances...

Are Bundled Payment Models or Capitation the Better Choice?

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  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation payment...

Should Accountable Care Organizations Include Social Services?

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While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according...

CMS Bundled Payment Models Lead to Greater Patient Selectivity

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What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint Replacement...

How Payers Could Assist Primary Care Docs with Value-Based Care

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How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers to these questions, HealthPayerIntelligence.com...

Highmark Partners with Aledade’s Accountable Care Organizations

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In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical treatment through accountable care organizations....

Key Challenges and Solutions of Healthcare Payment Reform

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Healthcare payment reform is becoming more common across payers and providers with many stakeholders transitioning from the traditional fee-for-service reimbursement system to value-based care payments. Representatives from the National Academy...

UnitedHealthcare Partners with Accountable Care Organizations

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In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members...

Top 3 Reasons to Partner with Accountable Care Organizations

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With value-based care reimbursement becoming the standard across health insurance companies and medical facilities around the country, stakeholders are investing more time and resources in accountable care organizations (ACOs). Why should healthcare...

Value-Based Care Drives Progress in Population Health Management

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Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health Technology...

How 3 Healthcare Insurers Expand Value-Based Care Payment

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National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based...

3 Ways Bundled Payment Models Brought Hospital Cost Savings

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Case studies of bundled payment models show significant cost savings among hospitals and both public and private health insurers. The Centers for Medicare & Medicaid Services (CMS), for instance, invested in bundled payment models for lowering...

Prospective vs. Retrospective Healthcare Bundled Payment Models

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When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. A prospective healthcare bundled payment model involves creating a budget when the episode...

5 Best Practices to Advance Value-Based Care Reimbursement

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When payers begin to transition to value-based care reimbursement from the more traditional fee-for-service payment system, company executives and financial experts may find it takes longer than expected to adopt the new payment structures while...

Medical Organizations Advise Changes for Quality Payment Program

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The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30 medical groups were concerned about MACRA regulations...

Accountable Care Organizations May Improve Diabetes Management

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Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American...

70% of Medical Groups Concerned About MACRA Regulations

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MACRA regulations have impacted the revenue cycle of providers across the country particularly regarding Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). The American Academy of Family Physicians outlined how...

5 Solutions for Conquering Challenges of Bundled Payment Models

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Despite strong optimism and stakeholder enthusiasm, a new bundled payment program operated by the Integrated Healthcare Association and the RAND Corporation faced major problems and delays. A report from the Agency for Healthcare Research and...

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