Value-based Care

2021 Employer-Sponsored Health Plan Spending Growth Hit 6.3%

by Kelsey Waddill

Costs for employer-sponsored health plans increased 6.3 percent in 2021, surpassing every annual increase since 2010, a Mercer survey discovered. “Employers seem optimistic that this...

Medicaid Managed Care Models May Improve Outcomes for Elderly, Disabled

by Victoria Bailey

Transitioning elderly and disabled Medicaid beneficiaries from fee-for-service Medicaid to a managed care model may lead to improved health outcomes and more than $100 billion of savings for states and...

Humana Expands Medicare Advantage Value-Based Contract in MN

by Kelsey Waddill

Humana has announced a multi-year, Medicare Advantage value-based contract to extend access to value-based care for members in Minnesota. “This value-based agreement for Humana Medicare...

Humana Shares 2020 Medicare Advantage Value-Based Care Results

by Kelsey Waddill

Humana’s Medicare Advantage value-based care efforts helped improve hospitalization rates and preventive care during the coronavirus pandemic, the payer shared in its value-based care...

12% of Payers Implement 10 or More Outcomes-Based Contracts

by Kelsey Waddill

Outcomes-based contracts continue to be popular for certain therapies as healthcare costs mount, an Avalere study found. Avalere’s findings draw on survey responses from 51 insurers and pharmacy...

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 Employers Can Control Costs with Episode-Based Benefit Plans

by Kelsey Waddill

As employers strive to help members lower costs, they can leverage episode-based benefit plans to guide their employees toward value-based care decision-making, according to a report from Manatt...

The State of Payer, CBO Social Determinants of Health Contracting

by Kelsey Waddill

Social determinants of health contracting with community-based organizations remains a complex and challenging task for payers as the demand for answers grows more pressing. As the industry’s...

Top 4 Policy Strategies To Diminish State Healthcare Spending

by Kelsey Waddill

State policymakers have a few tools at their disposal as they try to lower state healthcare spending, according to a Commonwealth Fund report. First, states can support greater competition between...

Payer Expands Value-Based Care Footprint for Clinical Procedures

by Victoria Bailey

Regence BlueShield (Regence) is welcoming new providers to its value-based care program and offering coverage for additional services to lower costs and improve patient health outcomes. The payer...

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...

AHIP, Other Stakeholders Support Medicare Value-Based Care Bill

by Kelsey Waddill

In a joint letter to the four representatives who introduced the bill in the House of Representatives, payer and provider organizations have thrown their support behind the Value in Health Care Act of...

How Payers Can Support Population-Based Payment Model Uptake

by Kelsey Waddill

As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately...

Behavioral Healthcare Parity Is Low Among Regional, State Plans

by Kelsey Waddill

Although the coronavirus pandemic has imposed significant changes on the healthcare industry particularly in regards to behavioral and mental healthcare, historically behavioral healthcare parity has...

Humana Plans to Acquire Value-Based Home Healthcare Partner

by Victoria Bailey

Humana has announced its plan to acquire One Homecare Solutions (onehome) from WayPoint Capital Partners in order to expand value-based care in home healthcare services. The acquisition accompanies...

4 Payers That Have Embraced Value-Based Care Models in 2021

by Kelsey Waddill

Updated 6/11/2021: This article has been updated with a quote from Blue Cross and Blue Shield of Minnesota's chief medical officer. A previous version included an quote from a partner of Blue...

UHC Changes Emergency Department Claims Evaluation Protocols

by Victoria Bailey

Editor's Note: UHC has delayed implementation of this policy. Find out more here. UnitedHealthcare (UHC) announced in a network bulletin that it will be changing some of its methods around...

Humana Expands Value-Based Care Model to Cover More Seniors

by Victoria Bailey

Humana’s CenterWell Senior Primary Care (CenterWell) is expanding its value-based care model to Original Medicare members to improve care quality and health outcomes, as well as lower the cost of...

Health System Joins Blue Cross NC to Expand Value-Based Care

by Victoria Bailey

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Mission Health have signed an agreement that will expand the benefits of value-based care to members across Western North Carolina and...