For all the wonderful advancement in health care diagnostics and therapeutics, the U.S. health care system has yet to solve for high costs of care while also improving outcomes. These […]

Population health, and the payment arrangements it supports, cannot be done successfully without incorporating social risk. Adoption of value-based payment The decade since the passage of the 2010 Affordable Care […]

Ever heard a primary care physician (PCP) in a value-based payment (VBP) contract say they shouldn’t be responsible for a patient they’ve never seen? Have your non-PCP, specialty providers (specialists) […]

If we want better health care outcomes in the U.S., we need to change the way we finance health care. Policies flowing from Medicare are a strong signal to the […]

Value-based payment (VBP) contracts have been taking hold across the spectrum of payers. Unfortunately, COVID-19 will make it difficult for VBP contracts to be settled. At some interval (usually yearly), […]

These times of uncertainty and stress press us to rethink what we are doing and where we are headed in terms of health care. I had a chance to speak […]

Value-based reimbursement is the soup du jour in the medical industry these days. How value is defined, however, can vary depending on one’s perspective. Most experts in the field agree […]

The pressure to improve healthcare outcomes and reduce unnecessary use of healthcare resources weighs heavily on hospital and health system administrators working with tight margins. Success under value-based payment requires […]

Within the CMS proposed rule for FY2019 published at the end of April, there is a proposal to consolidate and improve the value-based purchasing (VBP) payment adjustment model. On the […]

Recently, I reviewed the Medicare Hospital Value-Based Purchasing (VBP) scores for three hospitals recognized nationally for outstanding care and patient safety. They didn’t look good. The ratings for clinical outcomes […]

Hierarchical Condition Categories (HCCs) have been the underlying risk adjustment for many Medicare programs for several years. But they didn’t attract wide interest until CMS began shifting more payment toward […]

Value-based payment models are attracting attention for risk adjustment methodologies, especially HCC risk adjustment, which is used to calculate cost benchmarks for Medicare Advantage and other CMS payment models including […]