Screening for social determinants of health (SDOH) is increasingly done in primary and specialty care settings. Payers and health care organizations have recognized the importance of these determinants not just to clinical outcomes but also to cost and use of services. Toward that end, both clinical and financial cases have been made for an expanded focus on SDOH for many, if not all,…
The healthcare industry is likely still several years away from assuming full risk in value-based payment models, according to a new survey. A market in which the majority of value-based relationships include both upside and downside shared risk is three to five years off, according to nearly 40% of 185 healthcare executives surveyed by the HealthCare…
Accountable care organizations (ACOs) have become a major payment and delivery reform since they were introduced as a key component of the Affordable Care Act. Currently, there are more than 1,000 ACOs covering about 33 million lives across all payers—numbers that have steadily increased over time. The ACO model continues to evolve, but it seems to…
Accountable care organizations (ACOs) are part of the foundation of the healthcare industry’s transition to value-based care and purchasing. Since the passage of the Affordable Care Act (ACA), ACOs have realized clinical and financial improvements. Organizations in the Medicare’s largest ACO program average a quality performance score north of 90 percent, and CMS estimates that the…
Forrester Research has published a report summing up its impressions from the HIMSS19 Global Conference & Exhibition. Experts said they came away from the show convinced that big momentum is building behind interoperability, and it’s not coming from the places one might expect. Health systems will need to do better with the management and sharing…
As part of CMS (Centers for Medicare & Medicaid Services) Administer Seema Verma’s HIMSS19 speech on Feb. 12, she announced a new initiative that will enable MSSP ACOs to retrieve claims data for their beneficiaries. During Verma’s speech, in which she broadly implored the private sector to follow the government’s lead on making health data more accessible,…
Women receive health care that is below par, and the consequences are unnecessary morbidity and death. It is fact, not fiction—borne out by significant data that reveal disparities across many major conditions—that inattention to women’s unique symptoms, risk factors, disease biology and treatment effects are causing harm to women. Despite the reality, a poor body…
The Emory Healthcare Network, one of the largest clinically integrated networks in Georgia, connects physicians at its academic medical center, Emory University Hospital, with outside physicians in private practice. All physicians must participate in the network’s health information exchange so that everyone knows what’s going on, in real time, with their patients. All 327 primary…
Accountable care organizations (ACO) that have switched tracks to take on downside risk tend to be larger, located in urban areas, and more successful on financial metrics, according to a recent report. However, the report did not find any significant relationship between switching to downside risk tracks and improvement on quality or public health metrics. The…
Half of patients say convenience and access to care are the most important factors influencing their decision-making—and investors are looking to capitalize on this demand for convenience. Last year, venture capital investors poured $1.4 billion into on-demand health care services, including telemedicine companies (e.g., Doctor on Demand) and patient-centered drug delivery (e.g., Nurx and Hims). They’re all making…
CMS Administrator Seema Verma gave her first update on a major overhaul to the Stark law, saying that a key part of the regulation will remove a barrier to doctors participating in value-based arrangements. A major part of the agency’s updates to the anti-kickback law is clarifying areas of noncompliance for doctors and updating the…
The Centers for Medicare and Medicaid Services (CMS) recently finalizedchanges to the Medicare Shared Savings Program (MSSP), its primary accountable care organization (ACO) program and most significant approach to constraining ballooning program costs while improving quality. These changes will require ACOs to transition more quickly to two-sided risk. The program has continued to grow and demonstrated some savings,…
