Value-based Reimbursement

Humana Value-Based Care Program Unveils First Participants

by Kyle Murphy, PhD

Nearly seven months since announcing its value-based care incentive program for hospitals, Humana has revealed its first participants. Four hospitals have agreed to participate in the Hospital...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

by Chuck Green

The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review,...

BCBSAZ Shared Savings Program Reduces Hospital Readmissions by 26%

by Thomas Beaton

BlueCross BlueShield of Arizona’s (BCBSAZ) shared savings program has reduced 30-day hospital readmission rates by 26.3 percent while generating shared savings for providers.. BCBSAZ also...

Can Payers Reduce Stress of Alternative Payment Models for Physicians?

by Chuck Green

Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of...

60% of Employers Fail to Address Healthcare Spending Waste

by Thomas Beaton

Sixty percent of employers don’t capitalize on opportunities to address healthcare spending waste, even though they say wasteful spending is a key concern, according to a new survey from the...

Medicare Diabetes Prevention Program May Have Cost Concerns

by Thomas Beaton

The Medicare Diabetes Prevention Program (MDPP) may not fully cover provider costs needed to administer classes and other programs to prevent diabetes among Medicare members, says a new report from the...

NCQA, Health Plans to Measure Patient-Reported Outcomes

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has selected four health plans to test a new performance standard for collecting patient-reported outcomes measures, or PROMs. NCQA’s...

Narrow Network Alignment Could Drive Value-Based Payment Reform

by Thomas Beaton

Investment in high-performance narrow networks, creating new payment incentives, and leveraging digital innovation could help to increase adoption of value-based payment reform across the healthcare...

Payers Play Crucial Role in Healthcare Quality Transparency

by Thomas Beaton

Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP...

Patient-Centered Medical Home Model Saved BCBS of MI $626M

by Thomas Beaton

BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care. The payer...

How Capitated Payments Prompt Payer, Provider Innovation

by Thomas Beaton

The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies. Capitated...

Payers See Cost, Quality Gains with Value-Based Payment Models

by Thomas Beaton

Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of...

Next Generation ACO Model Saved Medicare $62M in 2016

by Thomas Beaton

Next Generation Accountable Care Organizations (ACO) saved the Medicare program $62 million during their first year of operation in 2016, encouraging CMS to expand downside risk models across...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs)...

Using a Commercial Shared Savings Program to Reduce Care Costs

by Thomas Beaton

A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce...

Rhode Island Aims to Expand Value-Based Care in Medicaid Program

by Thomas Beaton

Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are...

Highmark BCBS Saves $260M Using Value-Based Reimbursement

by Thomas Beaton

Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for...

CMS Approves Okla. Value-Based Drug Purchasing for Medicaid

by Thomas Beaton

CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on...

MedPAC: Value-Based Payment, Post-Acute Care Boost Medicare Savings

by Thomas Beaton

MedPAC has advised Congress that value-based payment reform and encouraging the use of post-acute care can help the Medicare program increase savings and improve beneficiary outcomes, the group said in...

Narrow Networks, Customer Satisfaction Contain Payer Spending

by Thomas Beaton

Payers can curb spending on medical care by investing in narrow networks and customer satisfaction tools, says a new PricewaterhouseCoopers (PwC) Health Research Institute (HRI) analysis. PwC found...