The most effective way to reduce the amount of money our country spends annually on healthcare – which now exceeds $4.1 trillion – is to help people avoid becoming sick in the first place. That’s the fundamental premise of value-based care (VBC), which focuses on improving patient outcomes and quality of care while driving down costs.
VBC is great in intent and theory, but many provider organizations today are struggling to meet the quality and financial metrics stipulated under these
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
Promise of Value-Based Care Through Engagement and Outreach
The transformation of the healthcare landscape is undeniable. With the industry moving toward value-based care, the emphasis has shifted from volume of services to the actual value or outcome of care delivered. And while value-based care holds providers more accountable for results, it also grants resources and time to provide better, more patient-centric care.
But even years into the shift, no comprehensive guidebook for success remains. While providers are rewarded for higher-quality
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Optimizing MIPS Value Pathways (MVPs) for Oncology Practices in 2025
The Centers for Medicare and Medicaid Services (CMS) introduced the MIPS Value Pathways (MVPs) as part of its ongoing revisions to the Merit-Based Incentive Payment System (MIPS) program, which was established in 2017 to encourage ongoing and consistent quality, efficiency, and improvement in medical practices. The MVP framework was designed to ease the burden imposed on clinicians and their administrators who participate in the MIPS program. Traditionally, MIPS scores have been calculated based
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Unpacking Medicare Advantage Terminations and How Plans Can Navigate Them
The U.S. healthcare system has been undergoing its own stress test. Stakeholders are currently experiencing a variety of pressures with a primary focus on finances, including administrative costs. The COVID-19 pandemic is often used as a convenient delimiter for the emergence of these problems, but in reality, tensions were brewing long before now and were caused by a variety of factors. Medicare Advantage (MA) is facing the headwinds of these issues – and as a result, MA
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Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains
What You Should Know:
- A new report from the Commonwealth Fund reveals that despite significant progress in expanding health insurance coverage under the Affordable Care Act (ACA), millions of Americans still lack adequate and affordable healthcare.
- The report highlights the prevalence of coverage gaps, high out-of-pocket costs, and the burden of medical debt, underscoring the need for further policy action to achieve truly universal coverage.
Uninsured and
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Medicaid & Health Equity: Addressing Disparities in Maternal and Mental Health
Recent advancements in healthcare, such as telemedicine, automation, and clinical studies, have propelled the industry forward, unleashing new possibilities for fostering better patient outcomes. While many are lucky enough to reap the rewards of new research and technology, critical communities are being left behind.
The Medicaid population, who typically benefits from progress last, still grapples with harmful biases within the healthcare system that pose extreme barriers to care. A new
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Parakeet Health Launches With $3M for GenAI Voice Platform to Enhance Patient Engagement
What You Should Know:
- Parakeet Health, a generative AI company focused on revolutionizing patient engagement, has announced the launch of its AI-powered voice platform and has secured $3M in seed funding to fuel its growth and development.
- This innovative solution aims to streamline patient communication for healthcare providers, improving efficiency, reducing costs, and enhancing the patient experience.
Addressing a Critical Need
With 90% of patients still
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The Imperative to Stay the Course on Value-Based Transformation
Is value-based care still the right strategy to reduce U.S. healthcare costs? Or is it time to move to what comes next in the generation-long battle to constrain total medical spending?
The question is being increasingly asked and with good reason. For 2024 medical costs are projected to rise 7.0% year over year for Individual and Group markets. That is greater than the medical cost trend in 2022 and 2023, which was 5.5% and 6.0%, respectively, and adds to a decade-plus of at least 5.5% per
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Strategic Cost Management Ensures ACO Viability
For ACOs to remain relevant as leaders of Value-Based payment models, they must step up now to generate more cost savings for Medicare patient care. Budget cuts for Medicare are once again under discussion by conservatives as political pressure mounts to lower governmental spending. Meanwhile, CMS is expanding risk in Medicare value-based payment models, moving quickly away from Fee-for-Service reimbursement. The new ACO PC Flex model is designed to create per-patient reimbursement for
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MEDITECH Launches Nationwide HIE Interoperability Network for U.S.
What You Should Know:
- MEDITECH launches Traverse Exchange, a new nationwide health information exchange (HIE) network designed to facilitate secure and efficient sharing of patient data among healthcare providers.
- Built on the foundation of the successful Traverse Exchange Canada, the new platform enables MEDITECH customers to exchange health information with other MEDITECH organizations and external systems that adhere to interoperability standards.
Transverse Exchange:
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