With enrollment in the Medicare Advantage (MA) program continuing to rise and nearly 50% of all Medicare eligible beneficiaries participating in an MA product, now is the time to evaluate the program’s benefits and possible unintended consequences. Why? A recent study by Landon et al., published in the Journal of the American Medical Association, compared the two programs… Read More »
In healthcare, particularly regarding new technologies, we habitually chase after the latest, greatest shiny object. And we very often accept these innovations as being beneficial even before the data is confirmed, sometimes even failing to terminate usage when it’s not shown to be of benefit. And Remote patient Monitoring (RPM) risks falling into that scenario. Hypothetically, the idea… Read More »
The desire to improve diagnostic accuracy, efficiency, and safety is always on the minds of clinicians. Suddenly, artificial intelligence (AI) arrives, and everyone believes we have found nirvana and a solution to all problems. Unfortunately, despite multiple peaks of excitement, AI still has failed to meet our expectations. When we delve into the reasons concerning diagnostic accuracy, it’s… Read More »
Historically, healthcare systems and social safety net providers have worked in parallel to provide care to their constituents. There have been many instances of cross-pollination and mutual support, but this is not the norm, nor is it done in a manner that significantly enhances the value to all involved parties. The need for collaboration in a meaningful way… Read More »
Since the formation of the Medicare Advantage (MA) program, there has been continuous growth in the number of Medicare beneficiaries that have chosen this model of care. The reasons are numerous. For instance, the pace of growth in the number of company offerings and members has picked up over recent years, and the current projection is that MA… Read More »
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 »
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 »
There has been considerable debate concerning the value of the Medicare Hospital Readmissions Reduction Program. The program was designed to deduct up to 3% of Medicare payments for hospitals with higher-than-expected thirty-day all-cause readmission rates, after index admissions, for six conditions and procedures. One of the primary concerns regarding the program was the disproportionate impact on teaching and… Read More »
There has been a great deal of focus on whether nonprofit hospitals bring value to the communities they serve in proportion to their tax-exempt status. The argument is that the tax dollars are necessary and properly utilized for community benefit; therefore, a tax-exempt status requires community benefit in replacement of payments. The measure used as a metric for… Read More »