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 »
As we continue to identify the benefits of telehealth, we must delineate how this form of technology most efficiently impacts primary care services. One can view such digital interventions as either substitutive or additional. If one utilizes an electronic visit instead of an in-person visit, this is an example of substitution. We are now categorizing this modality as… 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 »
Advanced payment models are designed to align reimbursement with the desired outcome of value (quality, service, and cost) for individuals. However, our current insurance models do not account for the desired short-term financial outcomes aligning with the much longer duration of care which is necessary to see clinical improvement. For example, to prevent heart disease, cholesterol management requires… Read More »
As we live longer, certain disease states will continue to become more prevalent in the elderly, such as dementia. Unfortunately, our health care system is focused on episodic care versus the needs of those with chronic conditions, especially when they need long-term services outside of a care setting. The question arises concerning who delivers such care, are they… Read More »
In our present financial models of healthcare reimbursement, the setup frequently places the physician and their practice staff in a real predicament. Consumers request that they deliver care during their time of need in a reverent and life-giving manner. Additionally, they are required to collect your co-pay and/or co-insurance while simultaneously understanding your benefit plan, including how much… Read More »
As value-based payment models have continued to expand, this expansion has occurred in the more affluent communities. Additionally, communities with more socioeconomically vulnerable individuals were less likely to be selected for joint replacement bundles, another form of a value-based payment. A big reason for this lack of equitable distribution of value-based care, can be linked to the absence… Read More »
In 2016, the Centers for Medicare and Medicaid Services (CMS) introduced the Overall Hospital Quality Star Rating Program to create transparency on hospitals’ quality, by summarizing dozens of metrics on the Hospital Compare website. There was considerable consternation over the validity of the data. In addition to comparing all hospitals to each other, regardless of unique dynamics, all… Read More »
Capitation, as a value-based payment model, has been around for decades. Many of us have experimented with variations of capitation, ranging from full capitation for all healthcare services to specialist capitation, to primary care (PCP) capitation. Currently, Primary Care Clinicians are much more comfortable with the nuances of these models because of the expansion of Medicare Advantage. This… Read More »
As we focus on delivering value-based care; higher quality at a more affordable price, the conversation concerning payment models rapidly pivots to global capitation for a population of lives. The opposite payment model is a fee-for-service model, and currently, there is a belief that service-based fees lead to an over-utilization of services. Consequently, many believe the only possible… Read More »