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

Value-Based Care News

Do Alternative Payment Models Overcome Fee-for-Service Flaws?


While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according...

CO’s Pediatric Care Network Brings Value-Based Care to Children


Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to...

Prioritizing Value-Based Care, Affordability in Medicaid


WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on...

MIPS Quality Reporting Flexibilities Trouble Providers, EHR Vendors


It’s good to have options when it comes to the clothes we wear, cars we drive, and things we do. But having too many options when it comes to quality reporting under MACRA’s Merit-Based Incentive Payment System (MIPS) may prove...

Payer, Provider Collab, Home Health Key to Integrated Care


WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle, Humana’s CEO and President Bruce...

Specialists Lack Medicare Alternative Payment Model, MACRA Options


Opportunities for specialists to join a Medicare alternative payment model are severely limited, especially for emergency medicine providers and audiologists, a recent Leavitt Partners report showed. As part of its effort to reimburse...

Few Specialists Prepared for MACRA Implementation, MIPS Reporting


All 800 specialty physicians surveyed in June by Integra Connect stated that they have yet to fully comprehend MACRA, resulting in few specialists investing in the capabilities needed for MACRA implementation. While 100 percent of the...

Cost Data to Improve Quality Reporting, Value-Based Purchasing


Providers enter value-based purchasing contracts without understanding the cost of quality reporting on measures listed in their contracts and payers rarely use cost data to determine which metrics to use when...

How Healthcare Reform, Value-Based Care Define High-Performance


Whether through the Triple Aim or Institute of Medicine’s six aims, healthcare reform efforts and value-based care models intend to transform health systems and hospitals into high-performing entities. But what exactly does it mean...

MSSP ACOs Decreased Spending by $1B, Improved Care Quality


Accountable care organizations (ACOs) participating in the first three years of the Medicare Shared Savings Program (MSSP) reduced Medicare spending, with a net reduction of almost $1 billion, according to a new OIG report. The analysis...

Readmissions, Post-Acute Care Drive Variation in Bundled Payments


Hospital readmissions, professional fees, and post-acute care payments are key drivers of cost variations for providers participating in 90-day cardiac bundled payment models, a recent JAMA Surgery study revealed. “These results...

Mixed APM Results Offer Lessons for Healthcare Payment Reform


The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the...

Private Sector to Drive Bundled Payments After CMS Cancellations


CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull...

Cost Savings Unclear for Medicaid Alternative Payment Models


Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and...

Accountable Care Organization Saves $4.8M With Nutrition Aid


A case study in American Health & Drug Benefits showed that Advocate Health Care, an accountable care organization in the Chicago area, reduced healthcare costs by $3,800 per patient, or $4.8 million in total, by implementing a...

Quality Payment Program, MIPS Top 2017 Regulatory Burden List


Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s...

Physician Expert, Clinical Documentation Key to MIPS Success


Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA...

Small Health System Achieves ROI with Asthma Management Clinic


Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on...

Accountable Care Organizations Grow, But Face New Challenges


Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient...

NQF Eyes Adding Social Risk Factors to Value-Based Purchasing


In response to stakeholder concerns that value-based purchasing programs unfairly penalize providers who treat greater proportions of disadvantaged patients, the National Quality Forum (NQF) recently endorsed 17 quality measures that...

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