CMS has finalized a rule which promotes private payers and states negotiating value-based purchasing contracts for Medicaid drugs, along with other changes.
The final rule was built upon the Medicaid...
Value-based care is a perennial goal for the payer industry, but transitioning into risk-based, outcomes-based contracts has proven to be a slow process.
However, Blue Cross and Blue Shield of North...
Humana has announced a new value-based primary care services model for Medicare Advantage members using the CMS Primary Care First model.
“The creation of this model comes at a critical time....
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...
In the San Francisco Bay Area, employers face the challenge of escalating healthcare spending.
This problem is not restricted to the Bay Area alone. Average premiums nationwide were around $7,470 for...
Blue Cross and Blue Shield of Minnesota (Blue Cross) struck a six-year value-based contract with Allina Health that focuses on quality improvement and cost savings through care coordination,...
A value-based care program from Blue Cross and Blue Shield North Carolina (Blue Cross NC) saw cost savings and quality improvement and increased provider participation in its first year, the payer...
Blue Cross Blue Shield of Massachusetts (Blue Cross) announced a new value-based payment model that offers small practices financial support through a global payment, upside risk incentives, and an...
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will financially support local independent primary care practices as they transition to value-based care during the coronavirus pandemic,...
CMS has proposed a rule that allows payers to adopt new value-based payment models for gene therapies.
“CMS’s rules for ensuring that Medicaid receives the lowest price available for...
The debate over the usefulness of prior authorizations for value-based contracting is often torn between providers who find the administrative elements burdensome and payers who find the programs...
Blue Cross Blue Shield of Massachusetts (Blue Cross) is expanding its value-based care model into its dental plan through value-based contracting with the dental provider group 42 North.
In 2019,...
Aetna Whole Health will offer employers access to self-insured and fully-insured plan options that focus on better care coordination through accountable care organizations (ACOs) and incorporating...
If value-based care in pediatric healthcare truly is the future of value-based care, payers need to leverage strong provider relationships to establish effective pediatric quality measures in order to...
Louisiana’s chief procurement officer recently threw out several multibillion-dollar Medicaid managed care contracts after uncovering the mismanagement of the bid process, according to national...
Eleven gene therapies could cost an individual as much as $45 billion over the next five years, but payers can bring that cost to a more manageable price range through methods such as value-based...
Blue Cross Blue Shield Michigan (Blue Cross) is initiating value-based contracts with seven major Michigan healthcare providers under their alternative payment model called the “Blueprint for...
Evidence is mounting to confirm that value-based care models are more cost-effective than fee-for-service, according to Humana’s fifth Value-Based Care Report, which said bundled payments and...
There are two elements of value-based care that should come as no surprise to a seasoned healthcare professional regarding value-based partnerships. First, that payer-provider relationships are at the...
UPMC Health Plan has entered into a value-based agreement with pharmaceutical manufacturer Biogen to be reimbursed for multiple sclerosis medications on the basis of disability...
