Value-based Care

USPSTF Recommendations Guide Payers on Preventive Care Screenings

by Kelsey Waddill

The US Preventive Services Task Force (USPSTF) has made a few preventive care screenings recommendations in recent months that payers should take note of for their preventive care and value-based care...

Strategies for the Physical-Behavioral Healthcare Integration Puzzle

by Kelsey Waddill

Physical and behavioral healthcare integration is a key aim for many private payers, but progress has been slow. Brett Hart, chief behavioral health officer at Centene, has more than 20 years of managed care leadership experience and is...

UnitedHealthcare Boosts Integrated Care Benefit Program To Up Value

by Hannah Nelson

UnitedHealthcare announced various enhancements to its integrated care benefit and specialty benefit approach for employer-sponsored health plans that are expected to simplify the member experience and...

Payer Launches Value-Based Kidney Care Agreement for CKD, ESKD

by Kelsey Waddill

Blue Cross and Blue Shield of Minnesota (Blue Cross) announced a value-based kidney care agreement with a DaVita Integrated Kidney Care program for members who have chronic kidney disease or end stage...

Social Risk Adjustment Promotes Health Equity In Value Based Care

by Hannah Nelson

Adjusting quality measures for social risk factors can promote health equity, according to expert guidance published in Health Affairs. As value-based payment programs expand, there is growing...

Disparities in Pediatric HMO Enrollment Draws Care Access Concern

by Hannah Nelson

Hispanic and Black children are enrolled in health maintenance organizations (HMO) at higher rates than their non-Hispanic White peers, based on research published in JAMA Network Open that draws...

Wellness Programs Are A Win-Win For Cost Saving, Member Outcomes

by Hannah Nelson

A digital therapeutic weight loss program led to major medical cost savings, according to a Rally Health Inc. study that points to wellness programs as cost-effective strategies to tackle the obesity...

Payer Platform for Self-Funded Employers Targets Member Engagement

by Kelsey Waddill

Self-funded employers take on the responsibility of covering their employees’ medical costs. The strategy is particularly appealing for large employers because they can exert more control over...

How Payers Can Identify, Reduce Low Value Care Spending Patterns

by Kelsey Waddill

Payers have the power to influence low-value care spending in a meaningful way. However, recent data has unveiled the reality that low-value care remains prominent in certain health insurance...

13 Areas of Low-Value Care Spending in Medicare Advantage Plans

by Kelsey Waddill

Although many studies have touted Medicare Advantage plans’ successes in diminishing low-value care and pursuing high-value care, there are at least 13 areas of low-value care in which Medicare...

Blue Cross NC Initiates Medicaid Managed Care Enrollment Period

by Kelsey Waddill

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) initiated enrollment in its new Medicaid managed care plan known as Healthy Blue, the payer announced. The Medicaid managed care plan has a...

Humana Will Begin Transitioning Senior Services Into New Brand

by Kelsey Waddill

Humana has announced that some of its senior services and other payer-agnostic services will begin to transition into CenterWell, the payer’s newest brand. Transitioning various services into...

NCQA Calls for Digital Quality Measures in Value-Based Care Plans

by Hannah Nelson

The National Committee for Quality Assurance (NCQA) released a report with health equity recommendations for HHS and CMS, including enabling a digital quality measure system and strengthening Medicare...

Healthcare Spending Frequency Impacts Affordability for Members

by Kelsey Waddill

Whether care is affordable for members depends on more than just pricing; affordability is also tied to how clustered healthcare events—and, by extension, healthcare spending—are in a...

Humana Launches MA Value-Based Care Model, Hospice Care Coordination

by Hannah Nelson

Humana announced the launch of a Medicare Advantage (MA) value-based care model for hospice patients, which aims to improve care coordination.  The program comes as part of a four-year...

COVID-19 Delays Value-Based Care Contract Negotiations

by Emily Sokol, MPH

Challenges to value-based care contract negotiations existed before COVID-19, but the pandemic set the movement back even further. Instead, provider and payer organizations have shifted focus from...

BCBS Introduces Value-Based, Patient-Centered Kidney Care Model

by Hannah Nelson

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has introduced a value-based care program that focuses on improving health outcomes for members with kidney disease through coordinated and...

Experts Call For Updated Medicare Advantage Star Ratings Survey

by Hannah Nelson

The survey that informs Medicare Advantage Star Ratings requires modernization to accurately gauge member experience and effectively promote value-based care, according to new research conducted...

CMMI Shares Lessons on Value-Based Care from Its First Decade

by Kelsey Waddill

In its first decade, the Center for Medicare and Medicaid Innovation (CMMI) introduced and honed models to support value-based care, exploring multiple avenues for lowering costs and refining risk...