Value-based Reimbursement

How Can Payers Support Providers Through Workforce Challenges?

November 16, 2023 - Although they likely existed before, the COVID-19 pandemic both highlighted and exacerbated workforce challenges among healthcare providers. Providers have implored federal leaders and agencies to increase support and resources as they operate amidst these challenges, but payers are also in a position to lend a hand. A key workforce challenge providers of all specialties are facing is...


More Articles

Growing ESRD Enrollment Prompts MA Plans to Form Value-Based Arrangements

by Victoria Bailey

Beneficiaries with end-stage renal disease (ESRD) are increasingly shifting from Medicare fee-for-service (FFS) to Medicare Advantage, leading more Medicare Advantage plans to form value-based...

Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM

by Victoria Bailey

Blue Cross Blue Shield of Michigan (BCBSM) is helping advance the shift to value-based care by initiating full-risk reimbursement arrangements with six provider organizations. The agreements are for...

AHIP: Next Steps Toward Primary, Behavioral Healthcare Integration

by Kelsey Waddill

AHIP called on providers and policymakers to join payers in their efforts to integrate behavioral healthcare and physical healthcare in an issue brief on the subject. The payer organization laid out...

Most Payers Are Unfamiliar with Prescription Digital Therapeutics

by Kelsey Waddill

Prescription digital therapeutics (PDTs) coverage remains nascent, as the adoption rate is only at 40 percent among the minority of payers who have familiarity with PDTs, according to a survey that...

How Benefit Design Can Steer Employees Toward High-Value Care

by Kelsey Waddill

When pursuing value-based care, employers have the capacity—in collaboration with their payer or third-party administrator partners—to steer their employees toward high-value care,...

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...

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...

Employers: Healthcare Spending Is on an Unsustainable Trajectory

by Kelsey Waddill

Overall, large employers find healthcare costs excessive and that the healthcare spending burden would become unsustainable in the next five to ten years, according to a recent Kaiser Family Foundation...

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...

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...

What Final Medicaid Value-Based Purchasing Rule Means for Payers

by Kelsey Waddill

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...

Ambulatory Surgery Centers Could Save Private Payers $3B

by Kelsey Waddill

Payers may consider promoting ambulatory surgery centers as the ideal site of care for joint replacement surgeries, UnitedHealth Group’s recent research findings suggested. “Findings from...

ACHP: Solidify Telehealth Flexibilities, COVID-19 Test Funding

by Kelsey Waddill

The Alliance of Community Health Plans (ACHP) urged Congress to take steps toward making telehealth flexibilities permanent and to ensure that coronavirus testing is available to consumers without...

Value-Based Care Stunted by Misaligned Payer-Provider Relationship

by Emily Sokol, MPH

A misalignment between payers and providers on their definitions of value, frequency of communication, and trust in their partnership is impeding value-based care efforts, according to research from...

Humana Launches Two More Value-Based Program for Specialty Care

by Kyle Murphy, PhD

The Louisville-based health payer is looking to build on its success in transitioning providers and members to value-based care with the announcement of two new models and twelve inaugural...

Louisiana Will Issue New Medicaid Managed Care RFP, Ends Protest

by Kelsey Waddill

Louisiana Department of Health will issue a new request for proposals (RFP) for Medicaid managed care organization contracts, ending a bitter legal battle over the 2019 RFP process, the department...

Supporting Safety Net Providers Through Value-Based Payments

by Emily Sokol, MPH

At the beginning of the coronavirus outbreak, many healthcare organizations halted elective procedures. While this helped increase hospital capacity for patients with coronavirus, it also took a...

4 Payer Data Points That Demonstrate Behavioral, Mental Care Parity

by Kelsey Waddill

Henry Harbin, MD, psychiatrist and advisor at The Bowman Family Foundation, and his colleagues are calling on health plans to start being more transparent about provider network behavioral and mental...

Providers Report Low Levels of Trust in Healthcare Payers

by Emily Sokol, MPH

Success in value-based care requires collaboration between payers and providers. They must work together to negotiate the terms of the contract, including outlining the quality metrics and incentives...