A CMS-run care delivery model focused on addressing social determinants of health has effectively identified higher cost and utilization patients while reducing potentially unnecessary emergency department (ED) visits, a new report shows. The Accountable Health Communities (AHC) Model reduced hospital ED visits by 9 percent for Medicare fee-for-service beneficiaries screened for health-related social needs, including housing instability,…

Low-value care spending among fee-for-service Medicare recipients dropped slightly from 2014 to 2018. However, two of the three services that make up the majority of low-value healthcare spending, antibiotic and opioid prescriptions, increased despite a national campaign to promote value-based care, according to a new RAND Corporation study. The researchers analyzed healthcare data of more than…

Although specialty care drives 40% to 60% of medical costs, specialists are often disconnected from accountable care organizations. Their fee and incentive structures are distinct, and too many care management systems don’t try to bring specialists into the fold. Specialists, however, are critical to care delivery—and they should be viewed as care partners and not…

ACOs participating in shared savings programs face a number of opposing forces in 2021. From a decline in the number of Medicare beneficiaries to new CMS regulations to force downside risk sooner, ACOs are carefully weighing their options in the year ahead. In fact, the number of ACOs participating in the Medicare Shared Savings Program…