As we begin to reflect on policy changes and how they impacted people during covid, It’s of utmost importance that we assess what enhanced our wellbeing and what did not. We know that a significant determinant of health, especially in children, is access to healthy food and permanent food security. One of the many policies during Covid was… Read More »
Currently, a significant portion of value-based care payments has focused on primary care-based models. Whether Medicare Advantage, Medicare Shared Savings Programs, Direct Primary Care, or other value-based programs, they all center on primary care clinicians and services. Though there are a few unique specialty-based models such as BPCI, the vast majority are not. These models have had a… Read More »
There is considerable discussion regarding aligning incentives to lower the total cost of care, and even more specifically, on the importance of diagnostic testing, the value it might bring, its accuracy, and the shared decision-making when ordering tests. Therefore, aligning incentives around appropriate diagnostic testing is critical to both diagnostic excellence and affordability of healthcare. Additionally, an important… Read More »
As clinicians, we spend a significant amount of our time attempting to diagnose what is ailing those we treat. And we have an armament of tests to select from and an extensive list of differential diagnoses, ranging from the probable, to the extremely rare yet, potentially fatal. Understanding the effectiveness of our diagnostic tests is important from multiple… Read More »
As consolidation and integration of physician practices occur, especially within organizations that can wrap capabilities around ambulatory clinical care, we must examine the potential benefit to those we serve. This ideal is also the premise for a clinically integrated network where payment models are designed to allow for enhanced capabilities available to smaller groups of clinicians. These enhanced… Read More »
For those in the value-based payment (VBP) world, we are constantly asking the question; “Is what we are doing impactful and adding value to quality, service, and costs, to those we serve?” A recent study in Health Affairs analyzed 20 years of commercial VBP studies and found mixed results. And from this information, it’s possible to formulate a… Read More »
For those in the value-based world, we have been on this journey for years. And we have witnessed and participated in CMS and CMMI creating and implementing various models. Undoubtedly, some have been more successful than others, and there has been an ongoing debate concerning the impact on value-based payment models. Two of the major concerns that have… Read More »
We are a country founded on individual rights. As a society, we have also decided that healthcare is a right of citizenship; we do not permit the denial of care based on one’s ability to pay. Unfortunately, the cost of the administrative components of the healthcare ecosystem is a burden on the overall cost of care. Many of… Read More »
In healthcare, we have become accustomed to ongoing Medicare regulatory oversight and changes. Many of these regulations are implemented to drive specific behaviors that are focused on improving quality and/or reducing costs. One such measure is the Medicare Two-Night Rule. This rule, created in 2013, was designed to replace the inappropriate inpatient admission status stays with what they… Read More »
As we continue to focus on value-based care, how we design our value-based payment models continues to be critical. Historically, we have oversimplified the polarity by placing a fee-for-service on one end of the spectrum and global capitation payments on the opposite side. Thus, creating the idea that these two payment mechanisms are counter to each other, and… Read More »