Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value Based Care

AMGA: Link Spending, Quality Performance for True Value-Based Care

by Jacqueline LaPointe

In response to a Request for Information from the Assistant Secretary for Planning and Evaluation (ASPE), AMGA recently called on CMS to “define value in a meaningful way” to ensure value-based care models incentivize providers...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline LaPointe

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline LaPointe

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care...

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

by Jacqueline LaPointe

The recent decision from CMS to cancel two mandatory bundled payments programs slated to launch in 2018 was a “step in the wrong direction for pursuing a healthcare system that focuses on value and not volume,” three physicians...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline LaPointe

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement...

Vermont ACO Receives $620M to Lead Healthcare Reform Efforts

by Jacqueline LaPointe

Vermont’s healthcare reform group, Green Mountain Care Board, recently approved a budget of $620 million for OneCare Vermont, an accountable care organization (ACO) working with Medicare, Medicaid, and private payers, local news...

Nearly 71% of Practice Revenue Under Fee-For-Service in 2016

by Jacqueline LaPointe

Fee-for-service was still the dominant source of medical practice revenue in 2016, the American Medical Association (AMA) recently reported. Almost 84 percent of physicians stated that their practice received fee-for-service revenue in...

60% of Federal Revenue to Come from Risk-Based Models by 2019

by Jacqueline LaPointe

Almost 60 percent of federal revenue and 37 percent of commercial revenue will stem from risk-based models by 2019, according to a new AMGA survey. The survey of 74 AMGA medical groups uncovered that Medicare and Medicaid fee-for-service...

Key Capabilities for Value-Based Reimbursement Models

by Jacqueline LaPointe

Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are...

High-Value Culture, Population Health Programs Key to ACO Success

by Jacqueline LaPointe

Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations...

Collaboration Key to Independent Physicians in Value-Based Care

by Kyle Murphy, PhD

At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists...

Family Physicians Slowly Embracing Value-Based Reimbursement

by Jacqueline LaPointe

Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The...

Six Characteristics of High-Value Primary Care Practices

by Jacqueline LaPointe

High-value primary care practices that achieved exceptional care quality at reduced costs shared six attributes centered around risk-stratified care management, mindful specialist selections, and care coordination, a new study in the...

Value-Based Contracts Rely on Patient Attribution, Data Sharing

by Jacqueline LaPointe

CMS aims to tie 90 percent of Medicare fee-for-service payments to quality by the end of 2018, with one-half of those payments to be paid under a value-based contract with some degree of financial risk. With ambitious goals from the...

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

by Jacqueline LaPointe

From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality...

Post-Acute Care Orgs Lack IT, Data Analytics for Value-Based Care

by Jacqueline LaPointe

Value-based care hinges on data analytics and provider communication across the care continuum. However, post-acute care providers do not have the health IT infrastructure or communication workflows in place to support value-based...

40+ States Have A Value-Based Reimbursement Adoption Strategy

by Jacqueline LaPointe

Over 40 states have a plan for value-based reimbursement adoption and only seven states have engaged in little to no activities relating to value-based healthcare payment reform, according to a new Change Healthcare report. The report...

Importance of Post-Acute Alignment, Integration to Value-Based Care

by Kyle Murphy, PhD

To achieve the ultimate goals of value-based care, healthcare organizations will need to assume greater responsibility over the patient’s experience across multiple care settings based on the appropriate level of acuity....

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline LaPointe

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal,...

Choosing Wisely Slow to Reduce Low-Value Care, Resource Use

by Jacqueline LaPointe

Participation in the Choosing Wisely campaign has significantly increased since its launch in 2012. But the campaign has yet to realize its goal of decreasing low-value care and resource use, a recent Health Affairs report...

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