Value-based Reimbursement

Overcoming the Barriers to Value-Based Payment in Primary Care

February 5, 2024 - Primary care is arguably the most critical component of our healthcare system. Primary care and preventive medicine can help avert and manage chronic diseases and prevent long-term complications. However, efforts to improve primary care delivery, such as value-based payment models, are lacking. That’s not to say that the industry doesn’t understand the importance of...


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New Medicaid Payment Model Targets Behavioral Health Integration

by Jacqueline LaPointe

CMS has announced a new Medicaid payment model that will incent care coordination across physical, behavioral, and social providers to improve the quality of care Medicare and Medicaid beneficiaries...

Primary Care Model Did Not Reduce Healthcare Spending or Improve Care

by Victoria Bailey

The CMS Comprehensive Primary Care Plus (CPC+) model was not associated with reduced healthcare expenditures or care quality improvements, a study published in JAMA found. CMS launched the five-year...

Does Medicare Value-Based Purchasing Exacerbate Racial Care Disparities?

by Victoria Bailey

Thirty-day mortality rates were higher for acute myocardial infarction and pneumonia at hospitals with higher shares of Black patients, suggesting that Medicare’s Hospital Value-Based...

Understanding the Value-Based Reimbursement Model Landscape

by Editorial Staff

The Centers for Medicare and Medicaid Services (CMS) aims to have all traditional Medicare beneficiaries under a value-based care model by 2030. Although the pace may be slow, the healthcare industry is shifting away from fee-for-service...

Despite Value-Based Care Growth, Room for Improvement Remains

by Victoria Bailey

Healthcare organizations are becoming more familiar with value-based care, but opportunities remain to improve and expand upon the care delivery model, according to a survey conducted by Sage Growth...

Understanding the Fundamentals of Accountable Care Organizations

by Editorial Staff

The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many value-based care models, accountable care organizations (ACOs) are...

More Provider Orgs Have Value-Based Contracts With Private Payers

by Victoria Bailey

More provider organizations are participating in value-based contracts outside Medicare, as three-quarters of respondents were under contracts with commercial and Medicare Advantage plans in 2022, a...

Value-Based Reimbursement Grows as Providers Take on More Risk

by Jacqueline LaPointe

Over half of healthcare payments last year were made through value-based reimbursement models, with most of those payments tied to some degree of financial risk, according to the latest data from the Health Care Payment & Learning...

How Vermont’s All-Payer ACO Model Paves the Way for Value-Based Care

by Victoria Bailey

As its name states, the Vermont All-Payer Accountable Care Organization (ACO) Model is an arrangement that incorporates patients with both private and public healthcare coverage, but what makes this model so appealing to providers? Is this...

Medicare Shared Savings Program ACOs Saved $1.8B in 2022, CMS Reports

by Victoria Bailey

The Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion in 2022, with 63 percent of accountable care organizations (ACOs) earning payments for their performance. This is the sixth...

CMS Will Test APM for Medicare Beneficiaries with Dementia, Caregivers

by Victoria Bailey

CMS has announced plans to test an alternative payment model (APM) to support Medicare beneficiaries with dementia and their unpaid caregivers. The Guiding an Improved Dementia Experience (GUIDE)...

Hospitals with Health Equity Factors Face Value-Based Penalties

by Jacqueline LaPointe

Hospitals with more medically complex patients, uncompensated care, and patients who live alone are more likely to receive a penalty under CMS value-based payment programs, according to a new study...

How Beneficiary Preferences Can Impact Hospital VBP Payment Incentives

by Victoria Bailey

If the Hospital Value-Based Purchasing (HVBP) program value weights were based on Medicare beneficiary preferences, nearly $86 million in payment incentives would be reallocated and smaller rural...

Study: Hospital Spends $5M Per Year on Quality Reporting

by Jacqueline LaPointe

Quality reporting is now a core function in healthcare, enabling value-based payment, transparency and accountability, and provider comparisons, to name a few benefits. However, quality data...

AMGA: Pharmacy Claims Data Key to Value-Based Care Progress

by Jacqueline LaPointe

Lawmakers have their eyes on pharmacy benefit manager (PBM) reform, but one bill is looking to take it a step further by requiring commercial payers to share pharmacy claims data with providers to...

Less than Half of Primary Care Physicians Participate in Value-Based Care

by Victoria Bailey

Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund. Value-based...

NAACOS Offers Guidance for Hybrid Primary Care Payment Model in MSSP

by Victoria Bailey

The National Association of ACOs (NAACOS) is calling on CMS to establish a hybrid primary care payment model in the Medicare Shared Savings Program (MSSP) using two possible approaches that will...

Community-Level Social Risk Adjustment Did Not Address Payment Disparities

by Victoria Bailey

Despite the notion that social risk adjustment may improve health equity in value-based payment models, incorporating community-level social risk factors into Medicare risk adjustment did little to...

Healthcare Orgs Push for Hybrid Primary Care Payment Option in MSSP

by Victoria Bailey

More than 25 healthcare organizations have urged CMS officials to establish a hybrid primary care payment option in the Medicare Shared Savings Program (MSSP) to enhance primary care and boost...