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Value-Based Care News

Population Health Approach to Prenatal Care Cuts Payer Costs

April 26, 2017 - Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations, said AHIP in a recent blog post, helping babies get off to a healthier start in life.  “With a wealth of data at our fingertips, health...


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Humana Expands Medicare Orthopedic Bundled Payment Programs

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The nation’s fourth largest healthcare payer recently announced it will be expanding its orthopedic bundled payment programs to eight new groups in Indiana and Kentucky.  The value-based care model will also offer participating providers...

Prescription Drugs Account for 22% of Payer Premium Spending

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Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

Can Value-Based Purchasing Work with Pharmaceutical Companies?

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The Network for Excellence in Health Innovation (NEHI) believes that developing value-based purchasing contracts between payers and pharmaceutical companies will be a critical next step for healthcare reform. Having payer and pharma companies...

APMs, Health Data Exchange among Top Payer Reform Goals

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The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

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The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

HFPP Provides New Resource for Payers to Combat Opioid Abuse

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A new 64-page report from the Healthcare Fraud Prevention Partnership (HFPP), a public-private partnership which includes CMS, gives payers resources that treat, educate, and develop improvements for combating opioid harm to patients. CMS has...

Healthcare Leaders Air Concerns about NQF SDS Trial Period

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A group of healthcare organizations wrote a letter to the National Quality Forum (NQF) calling for a one-year extension of the Sociodemographic (SDS) Trial Period that evaluates how social factors impact a hospital's or provider’s ability...

Emergency Coverage Top Healthcare Consumer Demand For Payers

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A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services. Out of the 1,791 healthcare consumers surveyed, about 31 percent...

Patient Satisfaction Key for Payer Measurement of ACO Quality

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An article from the American Journal of Managed Care reveals that patient satisfaction within an accountable care organization (ACO) is a strong indicator of the care quality level the organization delivers, giving payers an opportunity to use...

Impact of Wage Level Variation on Employer-Sponsored Plans

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Findings from a recent study of healthcare utilization and spending by four self-insured employers show a correlation between wage levels and the types of services received. Based on data on 42,936 employees at four self-insured employers that...

Social Determinant Data Key to Successful Risk-Based Contracts

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From bundled payment models to capitated healthcare payments, payers implement risk contracts to financially motivate providers to target high-cost and high-utilization patient populations to reduce overall healthcare costs. But increasing payer...

Two-Sided Financial Risk Model Reduces Socioeconomic Disparities

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A two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. Disadvantaged patients receiving...

State Medicaid Programs Invest in Accountable Care Organizations

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Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are 10 states that are managing Medicaid ACO programs...

Stakeholders Offer Key Principles for Alternative Payment Models

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More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and hindrances...

Are Bundled Payment Models or Capitation the Better Choice?

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  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation payment...

Should Accountable Care Organizations Include Social Services?

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While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according...

CMS Bundled Payment Models Lead to Greater Patient Selectivity

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What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint Replacement...

How Payers Could Assist Primary Care Docs with Value-Based Care

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How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers to these questions, HealthPayerIntelligence.com...

Highmark Partners with Aledade’s Accountable Care Organizations

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In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical treatment through accountable care organizations....

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