Hospitals are increasingly turning to value-based care initiatives to transform care delivery, lower the total cost of care, and improve patient outcomes. Unlike traditional fee-for-service (FFS) models that reimburse providers based on volume (i.e., the number of patient visits), providers are reimbursed based on the quality of care delivered in value-based care. Ultimately, success under these reimbursement models hinges upon seamless coordination between all stakeholders across the continuum
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Medicare Insurance| Regulatory, Policy, Patients Analysis, Insights - HIT Consultant
3 Ways Health Plans Can Improve Sleep Health for their Members
Getting a good night’s sleep should have nothing to do with having a great health plan — but it often does.
While some individuals can improve their sleep by making small changes, many who suffer from serious, chronic sleep disorders need a higher level of care and ongoing treatments, and many health plans offer insufficient benefits.
For example, Medicare covers sleep diagnostic tests under strict conditions, if patients are referred by a physician. Other health plans have denied
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Breaking Down the Implications of New No Surprises Act Regulations
The importance of the No Surprises Act (NSA) cannot be overstated, as surprise medical bills have long been burdensome for patients in the U.S. healthcare system. In fact, more than half of all U.S. consumers have received an unexpectedly large medical bills.
The purpose of the No Surprises Act is to prevent surprise out-of-network bills, often for emergency services. For example, if your appendix bursts while at work, you would be rushed to the nearest hospital for an emergency
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Unlocking Interoperability with a Blockchain-Powered Network
Achieving fluid data interoperability has been a complex and challenging goal for the U.S. healthcare system. The result of which has led to excessive administrative costs, delays in providing care, and significant patient frustration.
According to the Centers for Medicare and Medicaid Services, U.S. healthcare spending grew 9.7% in 2020, reaching $4.1 trillion, or $12,530 per person. This is forecasted to grow to $6.2 trillion by 2028, which will only exacerbate the current spending
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The No Surprises Act: How Payers Can Stay Compliant
As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the practice of billing a patient the difference between what their health plan covers and what the provider charges. Unfortunately, these bills are often the result of care provided in
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Healthcare Interoperability Has Arrived: 3 Ways to Harness the Potential
This year’s HIMSS Conference offered some exciting insights and a renewed focus on data-sharing and interoperability. While the healthcare industry has been extolling the virtues of data interoperability for years until recently it has remained one of the biggest obstacles to providing quality healthcare today. Yet, the tides are turning. New government regulations, like the Centers for Medicare & Medicaid Services’ interoperability rules and the Fast Healthcare Interoperability Resources
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Aledade Raises $123M to Expand Value-Based Primary Care
What You Should Know:
- Aledade, a Bethesda, MD-based provider of value-based primary care raises $123M in Series E funding to support investments in value-based care for more seniors covered by Medicare Advantage (MA) and innovation that improves patient care and increases medical cost savings, including expanded offerings through its new health services subsidiary, Aledade Care Solutions (ACS). Returning investor OMERS Growth Equity led the round, which also included Fidelity Management
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Rural Provider Homeward Forms In-Market Partnership with Rite Aid to Support Seniors in Underserved Communities
What You Should Know:
- Homeward, the comprehensive rural care provider network launched by former Livongo titan, Dr. Jenny Schneider, has announced a partnership with Rite Aid to deliver onsite care to rural Americans, starting with Medicare.
- Homeward’s work with Rite Aid will also support the pharmacy retailer’s recently announced plans to double-down on pharmacy services, with increased focus on expansion in underserved communities. This is also Rite Aid’s first push to bring real
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CareMax Acquires Steward Health’s Medicare Value-Based Care Business for $25M
What You Should Know:
- CareMax, a tech-enabled provider of value-based care to seniors announced an agreement to acquire the Medicare value-based care business of Steward Health Care System for a combination of cash and stock.
- CareMax will pay $25 million in cash and issue 23.5 million shares of CareMax’s Class A common stock to the equity holders of Steward at closing, subject to customary adjustments. In addition, CareMax will fund a Medicare receivable to Steward covering accounts
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Is It Finally Time for Hospital-at-Home or is Time Up?
All the signs point to a bright and expansive future for hospital-at-home programs, which have been growing steadily since the Centers for Medicare and Medicaid (CMS) created the Acute Hospital at Home waiver program in November 2020. As of March, nearly 100 health systems and more than 200 hospitals in 34 states had been approved for the program. Meanwhile, Forrester predicts the number of hospitals delivering acute care at home will triple in 2022. The reasons why are compelling: a study
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