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Value-Based Care| VBC-Related News, Analysis, Insights - HIT Consultant

Reveleer Launches AI-Driven Retrospective Risk Adjustment Solution

by Jasmine Pennic 03/05/2025 Leave a Comment

Reveleer Launches AI-Driven Retrospective Risk Adjustment Solution

What You Should Know: - Reveleer, a value-based care enablement platform launches its next-generation retrospective risk adjustment technology.  - The solution leverages artificial intelligence (AI) to improve the accuracy, efficiency, and compliance of risk adjustment programs for payers and providers. Transforming Risk Adjustment with AI In an increasingly complex healthcare landscape, accurate risk adjustment is essential for ensuring appropriate reimbursement and optimizing
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Aledade Adds 500 New Primary Care Practices to Value-Based Care Network

by Fred Pennic 02/11/2025 Leave a Comment

Aledade Adds 500 New Primary Care Practices to Value-Based Care Network

What You Should Know:  - Aledade, the nation's largest network of independent primary care providers, announced the addition of over 500 new primary care practices, clinics, and community health centers to its network.  - The expansion brings the total number of supported organizations to more than 2,400, serving nearly 3 million patients through value-based care programs across the United States. Fueling Nationwide Adoption of Value-Based Care Models   Aledade
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Transforming The Contact Center Into A Value-Based Care Engine

by Patty Hayward, General Manager of Healthcare and Life Sciences at Talkdesk 12/20/2024 Leave a Comment

Transforming the Contact Center into a Value-Based Care Engine

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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Unlocking Value-Based Care Through Accurate Provider Data

by Eric Demers, CEO of Madaket Health 12/20/2024 Leave a Comment

Unlocking Value-Based Care Through Accurate Provider Data

There’s no better illustration of the healthcare system’s data problems than this: 80% of entries in the nation’s five largest health plans were inaccurate as recently as last year. With a majority of patients relying on their health plan’s provider directory to select a physician, it’s not hyperbole to say incorrect provider data is dragging the entire industry down.  How can value-based care be realized when patients can’t find the provider information they need? Something as small as
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Promise of Value-Based Care Through Engagement and Outreach

by Joy Avery, MSN, RN, SVP, Clinical Strategy, CipherHealth, and Donna Pritchard, DNP, FNP-BC, MSN, RN, VP, Clinical Services, CipherHealth 12/16/2024 Leave a Comment

Delivering on the 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

by Erin Crum, Sr. Director of Quality Strategy and Innovation, The US Oncology Network and McKesson 12/12/2024 Leave a Comment

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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SOFHA and Lumeris Partner to Enhance Value-Based Care in Tennessee and Virginia

by Syed Hamza Sohail 11/15/2024 Leave a Comment

SOFHA and Lumeris Partner to Enhance Value-Based Care in Tennessee and Virginia

What You Should Know: - State of Franklin Healthcare Associates (SOFHA), the largest employee-owned, physician-led multi-specialty primary care group in the nation, has announced a new partnership with Lumeris, a leading value-based care enablement company, to improve healthcare delivery and outcomes in Northeast Tennessee and Southwest Virginia communities beginning in 2025. - By combining SOFHA’s exceptional provider care with Lumeris’ expertise in population health management and
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Arcadia: Transforming Healthcare with Data-Driven Solutions

by Syed Hamza Sohail 11/14/2024 Leave a Comment

**Arcadia: Transforming Healthcare with Data-Driven Solutions** Arcadia empowers payers and providers to harness the full potential of their data, driving transformation in healthcare. Through an interoperable data platform, Arcadia uses advanced analytics to shape strategies, inform decisions, and facilitate actions that improve patient outcomes, operational efficiencies, and financial performance. Trusted by leading healthcare institutions such as Southwestern Health Resources, Tandigm, Castell, Rush Health, and Beth Israel Lahey Health, Arcadia is at the forefront of healthcare innovation. **Newly Launched Solutions** Arcadia has introduced several cutting-edge solutions to support healthcare organizations in improving their performance: - **Enhanced Benchmarks**: This solution helps organizations analyze market-based cost, utilization, risk, and quality benchmarks alongside their own performance, uncovering opportunities for improvement. By integrating CareJourney’s market intelligence—comprising 100% of Medicare fee-for-service claims and Medicare Advantage encounters—with Arcadia’s de-identified benchmarks, it provides fresh, transparent insights at the provider, practice, facility, and network level. - **Arcadia Vista Push**: An analytics activation layer that simplifies the delivery of custom insights to providers at scale via email. This solution automates enterprise-wide performance reporting, driving awareness and engagement with performance improvement strategies. It also streamlines provider group reporting for payers, supporting better decision-making. **Future Innovations** Arcadia continues to invest in innovative solutions that will launch in the coming quarter: - **Arcadia Network Modeler**: Powered by a comprehensive database of over 745,000 providers nationwide, this tool allows healthcare organizations to design, build, and evaluate networks. It provides valuable insights to help expand into new geographies, manage existing networks more effectively, and ensure health equity, quality care, and an improved member experience. The solution integrates with Arcadia’s workflow tools to automate referral management and reduce administrative tasks. - **Arcadia Contract IQ**: This tool simplifies the design, negotiation, and forecasting of value-based care contracts. Featuring a form-based interface, it fosters collaboration across stakeholders, reducing data sprawl and simplifying contract complexities. It also enables "what-if" analyses for contract terms and acts as a decision support tool to determine the optimal contract type for specific populations. Additionally, users gain access to Arcadia’s actuarial partners for further insights. Arcadia’s continuous investment in advanced analytics and data-driven solutions is shaping the future of healthcare, enabling organizations to make informed, impactful decisions that improve care and efficiency.

What You Should Know: - Arcadia® (arcadia.io), a leading data platform for healthcare, today announced the launch of two new solutions—Enhanced Benchmarks and Arcadia Vista Push—designed to help healthcare organizations improve value-based care performance and deliver actionable insights at scale.  - The company also detailed a product roadmap that sets the pace for innovation in healthcare analytics. These announcements set a vision for how Arcadia will bring solutions to market that are
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How AI Can Drive the Transition to Value-Based Care

by Robert Connely, Global Industry Market Leader for Healthcare at Pega 11/01/2024 Leave a Comment

Harnessing Data for Value Based Care

The healthcare industry is at a crossroads, grappling with the dual challenges of declining health quality metrics and skyrocketing care costs. The reality is that health outcomes are driven more by what patients do than by what providers or payers do.  It is estimated that 80% of health outcomes are driven by non-medical factors – often social or behavioral risks that impact health and lead to poor outcomes and high costs. Value-based care (VBC) shifts this focus to helping the patient
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Value-Based Care is Growing – Is Your Data Ready?

by Rahul Sharma, CEO of HSBlox 10/21/2024 Leave a Comment

Value-Based Care is Growing – Is Your Data Ready?

The famous quote “What gets measured, gets managed” is often incorrectly attributed to business guru Peter Drucker. Although Drucker may not believe that maxim entirely, when it comes to value-based care (VBC), only care quality that can be measured and reported matters. Whether it is capitated, bundled, pay-for-performance, or hybrid VBC reimbursement models, the Centers for Medicare and Medicaid Services (CMS) and other payers typically have significant demands regarding quantitative data
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