Alternative Payment Models

Medicare Hospice Model Improved Quality of Life, Reduced Medicare Spending

November 30, 2023 - The Medicare Care Choices Model (MCCM) improved end-of-life care, increased hospice use, and reduced inpatient admissions for Medicare beneficiaries while simultaneously lowering Medicare spending, a study published in Health Affairs found. Beneficiaries can receive palliative care through the Medicare hospice benefit, but when choosing that route,...


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Employers Emphasize Quality of Care When Assessing Health Plans

by Kelsey Waddill

Two big shifts occurred among employers between 2020 and 2022: more employers reported that their health plans shared safety and quality of care data and more employers did not find their health...

Elevance Health ACO Generated Cost Savings Among Fully Insured Members

by Victoria Bailey

Elevance Health’s commercial accountable care organization (ACO) program was associated with significant cost savings between 2016 and 2021, particularly among the fully insured population,...

Medicaid Health Home Benefit Covers Children with Complex Conditions

by Kelsey Waddill

CMS has issued guidance for state Medicaid programs about how to use the Medicaid health home benefit to support children with complex medical conditions. “This new state plan option is about...

Value-Based Care in Diabetes Care Management Calls for Policy Changes

by Kelsey Waddill

Chronic disease management in diabetes may benefit slightly from value-based care and alternative payment models, but the results will not be substantial until certain policy changes take place,...

Payer Establishes Culturally Specific Alternative Payment Model

by Kelsey Waddill

CareOregon and the Alliance for Culturally Specific Behavioral Health Providers have developed an alternative payment model that seeks to empower culturally specific provider services. The newest...

CA Medicaid Plan Seeks to Streamline Pay for Performance Model

by Kelsey Waddill

CenCal Health, a Medicaid plan in California, is employing a pay for performance model to improve quality of care, called the Quality Care Incentive Program. “The new Quality Care Incentive...

Top Employer Strategies for Implementing Episodes of Care Models

by Kelsey Waddill

In order to best leverage episodes of care models, employers have to take more ownership of their own data and partnerships. When Kevin Lembo, former comptroller of the state of Connecticut, took on the role in 2010, the State of...

CMMI Aims to Lower Out-of-Pocket Healthcare Spending by 2030

by Kelsey Waddill

Updated 11/1/2021: This article has been updated to refer to the Centers for Medicare & Medicaid Services Innovation Center (CMMI) as a singular center. A previous version referred to...

How Benefit Design Can Steer Employees Toward High-Value Care

by Kelsey Waddill

When pursuing value-based care, employers have the capacity—in collaboration with their payer or third-party administrator partners—to steer their employees toward high-value care,...

Medicaid Subscription-Based Payment Models Show Mixed Results

by Kelsey Waddill

Using a subscription-based payment model to cover medication costs could have varying impacts on access to medication depending on the state that implemented the model, according to a study published...

Value-Based Care Challenges, Opportunities for Payers in 2021

by Kelsey Waddill

As payers continue to manage the coronavirus pandemic in 2021, this unique period in history presents alternative payment model and value-based care challenges and opportunities that are beginning to...

Medicare Value-Based Contracting Model Emphasizes Care Coordination

by Kelsey Waddill

CMS has introduced a new Medicare value-based contracting model that encourages greater care coordination and requires participants to take full risk for Medicare fee-for-service beneficiaries based on...

4 Strategies to Advance Value-Based Care During and After a Crisis

by Kelsey Waddill

How do major disruptions affect the US healthcare system’s progress toward value-based care? A recession, a widespread natural disaster, a public health emergency—significant national events like these have the power to build...

How To Scale A Telehealth Strategy: Pilots, Providers, and Payment

by Kelsey Waddill

Updated 6/18/2020: The new Blue Shield of California initiative is for Blue Shield of California members. A previous version of this article said the initiative served Blue Cross Blue Shield...

Building Payer-Provider Partnerships for Bundled Payment Models

by Emily Sokol, MPH

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

by Emily Sokol, MPH

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

by Kelsey Waddill

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...

BCBS NC, Quartet Partner to Implement Value-Based Payment Model

by Samantha McGrail

Blue Cross and Blue Shield of North Carolina and New York City startup Quartet have announced a partnership to implement a new value-based payment model for mental healthcare.   The...