Value-based Care

Wellcare partners with tech company to improve value-based primary care

March 14, 2024 - Wellcare, the Medicare brand of Centene Corporation, has partnered with a technology company to improve access to value-based primary care. The company, Pearl Health, focuses on physician enablement and risk-bearing in value-based care contracts. The multi-year collaboration with Pearl Heath will benefit Medicare Advantage beneficiaries by creating...


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A Look Inside the Four Most Common Value-Based Care Arrangements

by Victoria Bailey

A simple explanation of value-based care is rewarding quality over quantity. However, value-based care arrangements differ in how they determine payments and the level of risk that is assumed. As healthcare organizations warm up to the...

2024 Employer Sponsored Health Plan Predictions: GLP-1s, Vendors, Data

by Kelsey Waddill

Employers are stuck between a rock and a hard place in 2024, with unsustainable healthcare spending in their employer-sponsored health plans and a reticence to shift any more of the cost to their...

2024 Payer Strategies: Population-Based Plans, MA Differentiation

by Kelsey Waddill

The new year may look remarkably like 2023 from the payer perspective with a similar set of headwinds, but payer strategies may change. Health insurers will build on last year’s progress in...

How Healthcare Leaders Can Weigh Pros, Cons of Payer Megamergers

by Kelsey Waddill

When rumors circulate about major payers planning to merge, it always stokes the question: are payer megamergers ultimately good for the healthcare system? When the news broke that Cigna and Humana...

Understanding Chronic Kidney Disease Coverage, VBC Opportunities

by Kelsey Waddill

Efforts to improve chronic kidney disease coverage have evolved over the last several decades, but the disease remains costly and prevalent. Around 15 percent of the adult population in the US has chronic kidney disease (CKD), according...

Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members

by Victoria Bailey

Humana Medicare Advantage beneficiaries receiving care under value-based arrangements had better health outcomes, including fewer inpatient admissions and emergency room visits, a report from the payer...

Demystifying Medicaid Managed Care, Its Role in the Future of VBC

by Kelsey Waddill

As the US healthcare system slowly transitions to value-based care, Medicaid managed care organizations are joining the movement by promoting capitated payment models and quality-based assessments. California was the first state to test...

How Do Payers Approach Care Management Strategies, Technologies?

by Victoria Bailey

An essential element of value-based care success is proper care management. Care management revolves around team-based, patient-centered strategies that work toward helping patients manage their medical conditions in a cost-effective...

Blue Shield of CA Launches Value-Based Pharmacy Model to Lower Drug Costs

by Victoria Bailey

Blue Shield of California (Blue Shield) has launched a value-based pharmacy model to improve member access to affordable prescription drugs. The payer has partnered with five companies to deploy the...

Blue Cross of Idaho Invests in Digital Platform, Improving Senior Care

by Victoria Bailey

Blue Cross of Idaho and several venture capital firms have invested in Endear Health, a digital platform that aims to improve value-based care delivery for Medicare Advantage beneficiaries. The...

How Payers Can Reduce Emergency Department Admission Rates, Costs

by Kelsey Waddill

Members and payers do not always see eye-to-eye, but one point on which they closely align is their desire for members to stay out of the emergency department. Emergency department visits are associated with higher healthcare spending. A...

Value-Based Care and Fee-For-Service: What’s the Difference?

by Victoria Bailey

In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they...

Common Utilization Measures That Impact Value-Based Care Efforts

by Kelsey Waddill

Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality...

Unnecessary Utilization in CO Leads to $134M in Healthcare Spending

by Kelsey Waddill

Updated 8/24/2023: This article has been updated to reflect that the share of healthcare spending on low value care was highest in commercial health plans. Previously, the article framed...

How Long-Term Health Plan Enrollment Supports Value-Based Care

by Victoria Bailey

Realizing value-based care success is easier said than done. While a primary goal of value-based care is to improve long-term health outcomes and costs, that can be difficult when consumers’ healthcare journeys are disrupted each...

Aetna Injects $7.3M into Virginia FQHCs for Improved Cancer Outcomes

by Sarai Rodriguez

In partnership with the Virginia Community Healthcare Association (VCHA), Aetna Better Health of Virginia has allocated over $7 million in value-based care incentives to Virginia's federally...

CareSource Enters Value-Based Agreement to Improve Pediatric Health Outcomes

by Victoria Bailey

CareSource has entered into a value-based agreement with a clinically integrated network to improve pediatric health outcomes for Georgians. The partnership between the health plan and The...

Humana Collabs with DME Companies to Advance Value-Based Home Healthcare

by Victoria Bailey

Humana has entered value-based agreements with two durable medical equipment organizations to improve home healthcare services for Medicare Advantage members. The organizations, AdaptHealth Corp. and...

CVS Health ACO Partnership Expands Value-Based Care in Long Island

by Victoria Bailey

CVS Health is partnering with Catholic Health to expand value-based care for Medicare beneficiaries through the ACO Realizing Equity, Access, and Community Health (REACH) program. Under the ACO REACH...