Over the last ten years, policymakers of both parties have identified health care payment reform as a critical national priority. Payment incentives offered by Medicare and other large payers create the environment in which providers must choose between being rewarded for performing more services and procedures, as in fee-for-service medicine or, for efficiently managing the…
Southwestern Health Resources (SWHR) is an integrated health care network formed in 2015 with the purpose of filling gaps in care. It’s also part of one of the top Next Generation Accountable Care Organizations (ACOs) in the nation. Having an unwavering commitment to lowering “total cost of care” has been a main factor in that…
Specialists are key partners for delivering value-based care, particularly for patients with chronic diseases. This involves the appropriate diagnosis of conditions, including rare diseases, stewardship of diagnostics and value-based prescribing for specialty medications. Lawrence Kosinski, M.D., MBA, founder and chief medical officer of SonarMD, a tech-enabled care coordination solution for digestive health, notes the great…
The economic fallout related to the COVID-19 pandemic has yet to hit healthcare, but the result is likely to be an amplification of longstanding disparities within the U.S. healthcare system. Factors such as food insecurity, homelessness and access to care can affect a staggering 80% of patient outcomes. There is no single solution, and healthcare providers…
New bipartisan House legislation aims to boost the amount of shared savings that accountable care organizations can receive from the federal government to halt a slide in participation that has occurred over the past two years. The Value in Health Care Act reintroduced on Tuesday includes new requirements to study health outcomes for Medicare beneficiaries…
Download Slides What distinguishes a high performing Accountable Care Organization (ACO) from a low performing one? Is there a list of key ingredients that can predict success? While the answers to these questions are not simple, it is important for any value-based organization to understand what the right levers are that impact the greatest…
Nurses play a vital role in uncovering and addressing patients’ social determinants of health (SDOH), Julia Resnick, the American Hospital Association’s (AHA) senior program manager of strategic initiatives, told nurse leaders during AONL 2021, the annual conference of the American Organization of Nursing Leadership. “Health is more than just healthcare and there is a growing…
After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity…
With the changing healthcare landscape that is moving towards value, it is imperative for organizations to find and recruit high performing providers that will continue to drive high quality care at a lower cost. One of the ways to provide high-quality and efficient care is to build and expand your high-performance networks (HPNs). However, health…
Amid a return to utilization of in-person health care, telehealth and issues highlighted by the pandemic, such as health equity, will continue to grow in influence within health and well-being strategies, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions. AJMC®: Hello, I’m Matthew Gavidia. Today on the…
Amid pervasive workforce shortages and a growing demand for services, Optum Behavioral Health is working to reimagine the way behavioral health care is delivered. CEO Katherine Hobbs Knutson, who joined the company about a year ago, is leading the charge. “That divide between … what exists in the field versus what people actually have access…
Over the last decade, members of the medical and public health communities around the world have widely studied and acknowledged the impact of social determinants of health (SDOH)—the conditions in the environments where people live, learn, work, play, and age—on a wide range of health, functioning, and quality-of-life-risks and outcomes.[1] In the past year or…
