Rising out-of-pocket costs and barriers preventing or delaying the utilization of healthcare coverage highlight the need for a comprehensive approach that goes beyond insurance coverage alone and addresses the underlying issues affecting healthcare accessibility and affordability.
As providers look to find more stability as they pivot into VBC waters, they need to be conscious of the partnerships they forge on this journey. Done correctly, the right collaborative approach can have significant positive downstream impacts for all of a practice’s patients – even the ones not currently in a VBC plan.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
There is a huge opportunity for specialties to play a critical role in complementing primary care and tertiary care by transforming into a sustainable model that is preventive, boundaryless, and one that empowers patients and caregivers.
Brian Gragnolati, CEO of Atlantic Health System, said that "there's a war going on between providers and payers right now." In his view, payers “are doing everything they can” not to pay providers for the care they deliver. He said insurers have greatly increased their rate of denials and are extremely reluctant to take on risk in value-based contracts.
Only 21% of primary care physicians feel they are fairly compensated, according to a new report from Pearl Health. However, primary care physicians who participate in an ACO were 56% more likely than non-ACO participants to believe they are paid fairly. ACO participants were also 15% more likely to believe that the way they generate revenue allows them to deliver holistic care.
Main Street Health announced the close of a $315 funding round at HLTH — some of the investors included UnitedHealthcare, Humana, Elevance, Centene and CVS. The startup, which scales value-based care in rural areas for both Medicare Advantage and original Medicare patients, also announced that it is expanding to 26 states.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The digital health sector's quarterly investment trends seem to be stabilizing in 2023, according to a new report from Rock Health. The report noted investors are shifting their focus away from pandemic-era categories like telehealth and pharmaceutical R&D catalysts — instead, they're interested in startups creating products for disease treatment, the improvement of nonclinical workflows and the enablement of value-based care.
In a value-based partnership with ApolloMed, SCAN is launching a Provider Specific Plan called Compass. It is also announcing a Medicare Advantage plan designed for women called SCAN Inspired.
The advancement of value-based care cannot and should not exist solely in a payvider model, Intermountain Health CEO Rob Allen argued in an interview last week. Having its own health plan made things “a little easier” when Intermountain began getting serious about at-risk contracts, but achieving success in value-based care “is more about your commitment to the approach" and forging strong relationships with payers of all types.
As value-based care models take hold, the time is ripe for rehab therapists to position themselves as primary players in the movement toward delivering optimal quality and value in the broader healthcare ecosystem.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
The commercial market has struggled to adopt value-based care, but HealthPartners has had some success, according to Mark Hansberry, senior vice president and chief marketing officer of the company. During a conference, he shared five rules for scaling value-based care, including creating trust and providing real-time data.
For the gridlock in mental healthcare to be resolved, 100% of mental healthcare providers must practice measurement-based care, utilizing validated rating scales to monitor and measure longitudinal outcomes for every patient. And payers then must offer reimbursement that appropriately rewards providers for delivering high-quality, effective care, and incentivize proactive mental health management.
CardioOne, a startup built at Redesign Health, partners with independent cardiology practices to help them transition to value-based care. On Monday, the company announced it has raised $8 million in seed funding and has three new partners.
Through a new partnership with Walgreens, Pearl Health will work with primary care providers by offering its technology and data insights to help them better their care and transition to value-based payment models. Walgreens is then providing prescription fulfillment, medication adherence, immunization and diagnostic testing services.
The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.