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

Value Based Purchasing

Docs, Payer Execs Agree Providers Lack Tools for Value-Based Care

July 17, 2018 - A lack of technology and patient data may be stalling or even reversing the value-based care transition, a new survey of primary care physicians and health plan executives revealed. “Stalled Progress on the Path to Value-Based Care,” the third annual survey from Quest Diagnostics, found that over two-thirds (67 percent) of physicians and health plan executives think the...The survey’s finding is a change from last year’s results, which found that just 45 percent of health plan executives felt providers did not have the tools to succeed. Health plan executives also flipped their views on if the healthcare system as a whole has the tools necessary for value-based care. Fifty-four percent of health plan leaders now think the system does not...The same percentage point gap existed between both groups when asked if they agree or disagree that technological investments for quality initiatives have improved the value of healthcare for patients. Sixty-eight percent of doctors felt investments have increased value versus 80 percent of health plan executives. Disagreements over quality measurement highlighted the misalignment...Approximately one-half of respondents (47 percent) also thought blockchain could help the value-based care transition, with health plan executives being significantly more optimistic about the technology. Sixty-four percent of health plan leaders said that blockchain in healthcare would increase data sharing across organizations. But only 45 percent of physicians thought that...


More Articles

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

by Jacqueline LaPointe

Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO) recentl...“Since MIPS uses many of the same reporting and measurement mechanisms as the legacy programs, some stakeholders believe that small and rural practices may be less equipped to manage the administrative, technological, and financial bu...

More Execs Expect Value-Based Reimbursement to Up Profitability

by Jacqueline LaPointe

Approximately 46 percent of healthcare executives and managers expect value-based reimbursement contracts to improve their organization’s profitability, according to a recent KPMG survey. Healthcare leaders are more optimistic about t...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

by Jacqueline LaPointe

Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based reim...

ACOs and Other Value-Based Purchasing Models Have Yet to Cut Costs

by Jacqueline LaPointe

Accountable care organizations (ACOs) and other population-based value-based purchasing models have not decreased total cost of care or generated quality improvements at the market level, a new study found. The Healthcare Financial Manageme...

How Addressing Social Determinants of Health Cuts Healthcare Costs

by Jacqueline LaPointe

Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore, understanding...“Housing interventions are part of a wider recognition that addressing the social determinants of health, like housing, income, employment, education and food security, is a necessary component of the journey toward improved population heal...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs

by Jacqueline LaPointe

CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is cal...

Value-Based Care Reduces Costs by 5.6%, Improves Care Quality

by Jacqueline LaPointe

Value-based care strategies are starting to achieve the goals of the Triple Aim, payers reported in a new ORC International study commissioned by Change Healthcare. The analysis of 120 payers across a range of organization size and type rev...Researchers noted that for the first time in three years, commercial lines of business, not government lines are leading value-based payment adoption. Managed Medicaid and Medicare Advantage lines offered significantly less value-based paym...The value-based care models also resulted in care quality improvements. About one-third to one-half of payers said bundled payment models were very to extremely effective at improving care quality across all types of episodes analyzed. With bundled payment models realizing cost and quality improvements, commercial payers are increasingly adding the models to their value-based care portfolios. The analysis showed the following episode type adoption among commercial lines: As commercial payers engage with more bundled payment models, they are eclipsing government programs. For example, only 45 percent of managed Medicaid and Medicaid programs have maternity care bundles, and 47 percent of government programs ...

How Small Health Centers Can Succeed With Value-Based Payments

by Jacqueline LaPointe

Small community health centers should shift to a population-based mindset and deliver care management and coordination to succeed under value-based payment models, uncovered a new analysis from Health Center Partners of Southern California ...Deciding on what type of partnership is appropriate for the small community health center will depend on the capabilities needed at that particular facility for value-based payment success. For example, forging a relationship with a communi...

HHS Bringing Value-Based Purchasing to SNFs, Post-Acute Care

by Jacqueline LaPointe

HHS Secretary Alex Azar identified value-based purchasing as the key to reducing hospital readmissions and moving skilled nursing facilities and other post-acute care providers to coordinated community care. In a speech to the American Heal...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative paymen...

New Org Aims to Help Independent Practices with Value-Based Care

by Jacqueline LaPointe

The value-based care transition has been a thorn in the side of independent practices, but a group of leading provider organizations is aiming to better support solo practices in the current healthcare landscape through the formation of a n...

Only 4 CMMI Alternative Payment Models Met Spending, Quality Goals

by Jacqueline LaPointe

The CMS Innovation Center is on the path to reducing healthcare costs while improving care quality through alternative payment and care delivery models, a recent Government Accountability Office (GAO) report found. But only four alternative...In a report on whether the CMS Innovation Center has met its goals, the federal watchdog found that the agency’s innovation arm has partially met two of its three goals and completed the third. GAO found that the center has successful...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma to...

AMA Invests $27.2M in Health IT Co to Advance Value-Based Care

by Jacqueline LaPointe

The American Medical Association (AMA) recently invested another $27.2 million in Health2047 Inc., a health IT start-up in Silicon Valley that aims to tackle value-based care, physician productivity, and several other of healthcare’s ...

Practices Upping Healthcare C-Suite Bonuses for Value-Based Care

by Jacqueline LaPointe

Bonuses and incentive payments for healthcare C-suite executives are on the rise as medical groups and practices transition to value-based care, according to the most recent AMGA Medical Group Executive and Leadership Compensation Survey. T...“Some of the larger increases may be driven, in part, by differences in the demographics of survey participants year-over-year,” AMGA noted. “However, the general upward trend is consistent with other compensation survey d...

Practices Push for Quicker Value-Based Purchasing Transition

by Jacqueline LaPointe

The Council of Accountable Physician Practices (CAPP) recently urged policymakers to prioritize the value-based purchasing transition by accelerating the shift away from fee-for-service. “We recognize that much of policymakers’ ...

Orgs Not Living Up to Risk-Based Revenue Goals, C-Suite Says

by Jacqueline LaPointe

Provider organizations failed to achieve their risk-based revenue goals in 2017, according to the most recent State of Population Health survey by Numerof & Associates. The survey of healthcare C-suite executives showed that the majorit...Additionally, most executives in the 2015 survey thought that their organizations would be prepared to take on downside financial risk by 2017. Over half (59 percent) expected to be “very prepared” by 2017, but just 21 percent f...Possible threat of financial losses emerged as a top challenge to adopting alternative payment models involving risk-based revenue. About one-quarter of executives cited this as their number one obstacle. Researchers noted that executives i...Despite a lack of progress and several challenges, healthcare executives still felt the transition to population health management and risk-based revenue was worthwhile. Almost all respondents (95) percent rated population health a “m...Risk-based revenue from capitated contracts should particularly grow, executives noted. Only about one-half of respondents said their organization was in at least one capitated contract in 2017, and just 14 percent of respondents had more t...

Uniform Operational System Key to Value-Based Payments, CAQH Says

by Jacqueline LaPointe

The healthcare industry needs an “efficient, uniform operational system” to sustain value-based payment success, the Council for Affordable Quality Healthcare’s (CAQH) Committee on Operating Rules for Information Exchange ...

MD All-Payer Alternative Payment Model Met Medicare Spending Goal

by Jacqueline LaPointe

The Maryland All-Payer alternative payment model has already met and exceeded its five-year goal of reducing Medicare spending on hospitals by $330 million and the state is on its way to achieving care quality improvement goals, the state&r...By the third year of the alternative payment model, the Maryland Health Services Cost Review Commission found that the state has met or is on track to meet all of the goals set by CMS. The data showed a 1.53 percent average growth per capit...

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...