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Value-Based Care News

Why Maternity Care Needs Episode-Based Bundled Payments

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Episode-based bundled payments are becoming a sought-after reimbursement model throughout the healthcare industry. Along with the Centers for Medicare & Medicaid Services and its focus on implementing bundled payments, private payers are...

Why Accountable Care Organizations May not Succeed in MSSP

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Do accountable care organizations (ACOs) truly save costs for the healthcare industry? Or is forming an ACO in hopes of cutting spending a pipe dream? Last year’s results from the Medicare Shared Savings Program (MSSP) showed little positive...

Humana’s Top Suggestions for Operating Bundled Payment Models

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The major health payer Humana will be moving toward adopting additional bundled payment models that will serve Humana Medicare Advantage members. The payer will be partnering with four orthopedic specialty establishments through these bundled...

Top 3 Ways Accountable Care Organizations Could Garner Savings

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Payers and providers looking to operate through an accountable care organization (ACO) will need to adhere strictly to state and federal laws regarding the development of this model of care. Accountable care organizations are responsible for...

CMS Bundled Payment Program Reduces Costs for Consumer

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At the end of last year, the Centers for Medicare & Medicaid Services (CMS) finalized their bundled payment rule for hip and knee replacement surgery. This type of bundled payment program will hold hospitals more accountable for patient health...

Service-Based Organization Strengthens Population Health

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Blue Cross Blue Shield of Arizona (BCBSAZ) has recently partnered with McKesson Business Performance Services to form a service-based organization called ACO Partner meant to function in the evolving value-based care reimbursement environment...

Commercial Accountable Care Organizations Denied Tax Exemption

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The Centers for Medicare & Medicaid Services (CMS) has undergone significant reforms in recent years in order to reduce wasteful healthcare spending and improve patient health outcomes around the country. Some of these changes include...

How to Prevent Healthcare Underuse in Bundled Payment Models

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Value-based care reimbursement including bundled payment models or accountable care organizations may help medical providers and payers achieve the Triple Aim of Healthcare which is better patient care, stronger population health outcomes, and...

Accountable Care Organizations Keep Growing Across US

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The Patient Protection and Affordable Care Act led to the  development of the Medicare and Medicaid Innovation Center, which eventually brought the creation of accountable care organizations and the Medicare Shared Savings Program....

CMS Continues to Reform through Healthcare Bundled Payments

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As of April 1, 2016, healthcare bundled payments have become a part of the reimbursement strategy of hospitals providing hip and knee replacement surgeries as well as the Centers for Medicare & Medicaid Services (CMS) itself. Through the...

How CMS Could Boost Operation of Accountable Care Organizations

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Accountable care organizations (ACOs) have become a more mainstream method for improving care coordination and the quality of medical services while providing an opportunity for reducing wasteful spending. For instance, St. John Health System’s...

CMS Bundled Payment Model Reduced Hospital Stays to 2.9 Days

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Slowly, healthcare providers are moving their reimbursement toward the bundled payment model across some of their medical services.  The Centers for Medicare & Medicaid Services (CMS)  along with commercial health  insurers...

Concierge Medicine Model Impacts Population Health Management

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The concierge medicine model is becoming more and more prominent around the nation, as healthcare providers continue to adopt the new payment system. While many hospitals and physicians are finding medical payment reform and the move toward value-based...

Aetna, Mount Sinai Invest in Accountable Care Organizations

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Since the Affordable Care Act was passed and the Center for Medicare & Medicaid Service Innovation established the Medicare Shared Savings Program, the development of accountable care organizations began to blossom quickly. Along with CMS,...

Bundled Payment Models Need to Align Payer, Provider Incentives

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Bundled payment models are growing in popularity throughout the health insurance industry partially due to the Centers for Medicare & Medicaid Services (CMS) pushing forth alternative payment structures as well as the general goal of reducing...

‘The Future is Accountable Care,’ Population Health Management

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Effective population health management remains a key aspect of running a successful accountable care network. As part of a stronger population health management program, the primary care physician’s referral system must be efficient in...

5 Elements Essential for Value-based Care Reimbursement

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The health insurance industry has been undergoing significant changes ever since the Patient Protection and Affordable Care Act became law and rising healthcare spending brought a need for payment reform. More payers have been targeting value-based...

Healthcare Bundled Payments, Silver Plan Changes Impact Payers

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The federal government especially the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have targeted healthcare payment reform in an effort to reduce rising medical costs around the nation....

Healthcare Spending on Brand Name Drugs Grew 8% in 2014

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Healthcare spending for the average insured consumer does not seem to be decreasing or even stabilizing, finds a report from the Health Care Cost Institute (HCCI). In fact, healthcare spending among insured individuals living in the United States...

Population Health Vital for Alternative Payment Model Success

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The Department of Health and Human Services (HHS) has given the healthcare industry three years to transition toward alternative payment models. HHS Secretary Sylvia Burwell announced last year that, by the end of 2018, the Centers for Medicare...

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