Jef Mertens’ Post

Primary care population-based payment (PBP) models are upfront, value-based payment approaches that pay providers based on the number of patients they serve, as opposed the number of services they perform, while also giving providers greater flexibility in how they deliver care. This primer by Center for Health Care Strategies explores six key design choices that states need to make when developing or refining a PBP model and the implications of these choices. https://bit.ly/3JMrgOS

Informative read from HFMA: 'A crisis of faith regarding value-based care - Finance executives surveyed for HFMA's third and final series of 'Healthcare 2030' reports describe an industry not ready to tie payment to value, with some wondering if there is a need to do so'. https://lnkd.in/e9m8w6Gj #valuebasedcare #healthcare #healthcarefinance #healthcareprofessionals #hospitalmanagement #healthinsurance #feeforservice #policymakers #cms #medicaid #medicare #riskcontracts #caremanagement #businessstrategist #businessanalysis #behavioraleconomics #economics #regulatory #healtheconomics

ConcertoCare’s value-based, in-home care model is transforming support for Medicare and Duals members while delivering health plan cost savings. For payers, an investment in ConcertoCare's program pays dividends through reduction of unnecessary ED visits and admissions, prevention of readmissions, and reductions in the need for costlier institutional care. It's a win-win for health plans, their members, and the health system at large.

Excellent overview of where we are with the value-based transition. Authors highlight that VBP has shown successes, such as Medicare’s Comprehensive Care for Joint Replacement program saving $61.6 million and the Medicare Shared Savings program yielding over $8 billion in savings. However, challenges remain, including complex requirements and inadequate data for physician practices, and risk adjustment issues leading to "ghost savings." To accelerate VBP adoption, practices need better financial tools and data integration. Despite inherent difficulties, VBP aligns with physicians' motivations to improve care, but requires enhanced methods for assessing risk and measuring value to achieve its full potential. Abode Care Partners BrightSpring Health Services Jackie Lichwell Caitlin Jones, M.S., CCC-SLP AMDA - The Society for Post-Acute and Long-Term Care Medicine

There is a lot to think about in our flawed healthcare system --- and while this is one of many issues its focus on insanely high costs is unfortunate since it glosses over an even more concerning issue: quality of care. Our diminished longevity and high infant mortality are appalling --- but neither is the result of high costs. All too true that government's role has added to costs, but the scarier parts of government involvement are that the government "cure" for any problem is to double down on what is wrong by with more money (and we already know that money does not improve quality of care) and bureaucratic intrusion into every step of the process from diagnostics to treatment protocols. The issue of quality of care is the most important concern yet gets the least attention. And that, folks, is a discussion for another time. This is a good read --- but it's just a starting point if you are serious about health care.

In today's healthcare landscape, ensuring health equity among patients is essential to provide every patient with the same level of care. By optimizing health equity, every patient should have a fair opportunity to achieve ideal health. Alternative Payment Models (APMs) play a crucial role in health equity with the rise of value-based care as they incentivize high-quality, coordinated healthcare models. Some challenges remain, such as accurately measuring disparities and standardizing data collection, but there's growing optimism for meaningful progress towards advancing health equity across the board. 💡 Priority Practice Management can help optimize your healthcare practice to relieve the administrative burden of running it yourself. Learn more on our website ➡ https://lnkd.in/gpYmTyzz #ValueBasedCare #PracticeManagement #RevenueCycle #HealthEquity 📖 Article: https://lnkd.in/gCKdZ67u

On September 5, 2023, CMS released a new, voluntary state total cost of care model called the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Healthcare strategy expert Patrick Pilch discusses 5 key considerations that health systems in potential participating states should be aware of: https://ankura.co/3HzLcUd

The US #HealthCare industry continues a predominant fee-for-service provider reimbursement model, despite trying to shift to a #ValueBasedCare model for now approaching two decades. Moreover, providers continue to be consumed in a figurative avalanche of paperwork. It is a challenging system for both practitioners and patients, often delivering unpleasant experiences for both. Read more about this in our new publication by Meade Monger in Medical Economics: https://lnkd.in/eWtzfQU5

Healthcare in the U.S. is in crisis but value-based care estimated to add $1 Trillion in value. You nailed it. Irem Rami, Sam Lesser, Suraj Shah, Unmesh Srivastava #healthcare #medicare #healthequity

"Federally Qualified Health Centers Can Make the Switch to Value-Based Payment but Need Assistance" Here's a key insight for all my fellow healthcare professionals: transitioning to value-based payment models presents an incredible opportunity for Federally Qualified Health Centers (FQHCs) to enhance care quality while managing costs effectively. However, it's clear that navigating this shift requires substantial support and resources. The challenge lies not only in the adoption of new payment structures but also in ensuring that these changes lead to improved patient outcomes without adding undue strain on already stretched-thin healthcare providers. This evolution underscores the need for collaborative efforts, including policy adjustments, financial incentives, and educational resources to empower FQHCs through this transition. It's about building a sustainable future for healthcare that prioritizes patient health and community well-being. For a deeper dive into the intricacies of this transition and the support FQHCs need, check out the full piece below: