Value-based healthcare
Value-based care is a reimbursement model wherein payers compensate providers based on key metrics for care quality, care coordination and health outcomes. Value-based care aims to reduce healthcare costs and improve patients’ experience and health by using health information technology for data collection, analysis and sharing among providers.
Top Stories
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News
05 Aug 2024
Members rarely challenge coverage denials, surprise billing
Only 45% of individuals who received a surprise bill challenged it and only 43% of those who were denied coverage appealed the decision. Continue Reading
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Feature
01 Jul 2024
A VBC approach to improving pediatric behavioral healthcare access
Behavioral healthcare access for children and adolescents is lacking, but payers can use value-based care systems to increase and optimize referral opportunities. Continue Reading
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02 Nov 2020
How Payers Can Identify Partners for Automated Data Transfer
Trustworthy automated brokers that can facilitate automated data transfer will have broad provider and vendor networks and a proven history of successful transfers. Continue Reading
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28 Oct 2020
How a Directory Can Streamline Interoperability Rule Compliance
The CAQH directory may support interoperability rule compliance by testing endpoints in advance and allowing payers and vendors to quickly access each others’ information. Continue Reading
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27 Oct 2020
Health Literacy Improves Medicare Spending, Member Outcomes
If improved nationwide, high health literacy could lower Medicare spending by $25.4 billion and lead to more preventive care services and better member outcomes. Continue Reading
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26 Oct 2020
59% MA Plan Proxies Rate End-of-Life Care Quality “Not Excellent”
Medicare Advantage beneficiaries receive poorer end-of-life care quality than traditional Medicare beneficiaries do, a survey of beneficiary proxies revealed. Continue Reading
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26 Oct 2020
Cancer Patients Paid $5.6B Out-of-Pocket Cancer Costs in 2018
Health payers are in a position to take responsibility for and address patients’ high and rising out-of-pocket cancer costs. Continue Reading
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22 Oct 2020
Navigating Generational Differences in Member Engagement
Payers can leverage new data about behavioral health to transform and rectify member engagement among Millennials. Continue Reading
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Answer
16 Oct 2020
Key Considerations for Permanently Integrating Telehealth Coverage
As telehealth transitions from a nice-to-have benefit to an essential form of care delivery, payers will have to make some adjustments in order to permanently integrate telehealth coverage expansions. Continue Reading
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14 Oct 2020
Payer Premiums, Out-of-Pocket Costs Burden Medicare Beneficiaries
More than six in ten Medicare beneficiaries who struggled to meet a healthcare bill in the last year reported that the bill was either an out-of-pocket insurance bill or an insurance premium. Continue Reading
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13 Oct 2020
Payers Integrate Virtual, In-Person Social Determinants Support
As businesses and health centers slowly reopen, these payers are finding ways to provide social determinants support both through virtual technology and in-person services. Continue Reading
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09 Oct 2020
Top Strategies For Driving Down Prescription Drug Spending
Payers can implement drug price transparency tools, revamp their formularies, and emphasize preventive care to reduce prescription drug spending. Continue Reading
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07 Oct 2020
Humana’s Value-Based Care MA Model Cuts ED Admissions, Costs
Members in Humana’s value-based care Medicare Advantage plans had lower hospital admission rates, but preventive care screenings dropped due to the pandemic. Continue Reading
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05 Oct 2020
Benefits of Digital Quality Measures for Payer Quality Reporting
Digital quality measures not only reduce provider burden, but they also can be essential for payers during a major disruption to the healthcare system. Continue Reading
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02 Oct 2020
3 Common Telehealth Technologies that Payers Cover, Leverage
Within the CDC’s three telehealth modalities, payers commonly turn to telehealth technologies including phone calls, secure direct messaging, and remote patient monitoring. Continue Reading
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01 Oct 2020
Medicaid Expansion Could Mean $5.4B in Federal Funds for TX
If the state of Texas embraced Medicaid expansion, it could receive $5.4 billion in federal funding and could extend coverage to over 900,000 currently Texans. Continue Reading
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30 Sep 2020
Surprise Billing Policies May Decrease Commercial Payer Premiums
Researchers have discovered that enacting reimbursement reductions related to services that frequently result in surprise billing could put a dent in members’ premiums as well. Continue Reading
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28 Sep 2020
Value-Based Care Stunted by Misaligned Payer-Provider Relationship
Payer and provider misalignment inhibits the success of value-based care, according to a recent report from Insights by Xtelligent Healthcare Media. Continue Reading
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25 Sep 2020
Payer Strategies For Home Healthcare, Remote Patient Monitoring
By implementing certain home healthcare and remote patient monitoring strategies, payers can boost their value-based care delivery. Continue Reading
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22 Sep 2020
Key Quality Measures for 2020, How to Select Measures Effectively
The Core Quality Measure Collaborative’s four updated quality measures shed light on essential payer quality measures and may guide payers through the quality measure selection process. Continue Reading
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21 Sep 2020
Private Payers Pay Hospitals 247% of Medicare Reimbursement Rate
Employers can get involved in equalizing private payer rates with Medicare reimbursement rates by re-evaluating their contract negotiation process and reforming their benefits. Continue Reading
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18 Sep 2020
12 Leading Medicare Advantage Payers by 2020 CMS Star Ratings
These twelve Medicare Advantage payers earned the highest scores in Medicare Advantage Star Ratings going into 2020, a year that has tested Medicare Advantage plans. Continue Reading
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17 Sep 2020
COVID-19 Amplifies Racial Health Disparities for Coverage
By the end of 2020, two million Black individuals and three million Hispanic people may have lost their employer-sponsored health insurance, deepening racial coverage and health disparities. Continue Reading
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News
17 Sep 2020
How Medicare Successes Inform Medicaid Value-Based Care Progress
There is no single solution that all states can use to expand Medicaid value-based care, but Medicare payment models may help guide state efforts in Medicaid. Continue Reading
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14 Sep 2020
UnitedHealthcare Launches Concierge-Style Plan, Free Primary Care
The companies project that the concierge-style health plan will save members up to 25 percent on premiums and will have access to free urgent care and primary care services. Continue Reading
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11 Sep 2020
4 Strategies to Advance Value-Based Care During and After a Crisis
Four experts in value-based care share how a major disruption to the healthcare industry, like the COVID-19 pandemic, could be used to advance payer value-based care progress. Continue Reading
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10 Sep 2020
MA Special Needs Plans May Lower ESRD Spending, Improve Outcomes
Medicare Advantage special needs plans may lead to lower utilization and lower mortality rates than fee-for-service Medicare. Continue Reading
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10 Sep 2020
How States, Employers Control ESI Healthcare Spending Long-Term
Some states and major employers are finding ways to establish long-term controls on employer-sponsored insurance healthcare spending. Continue Reading
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09 Sep 2020
Payer Empowers Grassroots Movement to Tackle Opioids Epidemic
A passion for providing substance abuse care and patient advocacy at Highmark Health has created a movement to empower reform around the opioids epidemic. Continue Reading
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08 Sep 2020
CA Legislature Expands Behavioral, Mental Healthcare Parity Law
The bill aims to fill gaps left by the Affordable Care Act and promote patient-centered mental and behavioral healthcare. Continue Reading
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03 Sep 2020
How Payers Can Leverage Centers of Excellence to Boost Quality
While the industry struggles to define centers of excellence, there are some key ways that payers can identify these organizations and leverage them to improve quality of care. Continue Reading
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02 Sep 2020
Employers Unaware of How to Compare Health Plan Quality Measures
Employers not only struggle to assess health plan quality measures, but are also discontented with the plan selection process overall. Continue Reading
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31 Aug 2020
Payer, Provider Value-Based Contract Targets 10% Lower Cost Trend
The value-based contract will seek to achieve 10 percent lower cost trend over five years through telehealth usage, preventive care, and coordinated care strategies. Continue Reading
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31 Aug 2020
How Payers Can Calm Member Fears, Push Virtual Care Adoption
Although adoption is currently high, member privacy and security concerns as well as access restrictions could cause virtual care adoption to regress after the pandemic stabilizes. Continue Reading
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28 Aug 2020
How to Assess Potential COVID-19 Employer-Sponsored Insurance Loss
Coronavirus-related employer-sponsored insurance loss may be lower than researchers projected due to differing assumptions. Continue Reading
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27 Aug 2020
4 Population Health Strategies Payers Use for Back to School
Whether children are going back to school in person or virtually, payers have a role to play in ensuring that they stay healthy by incorporating strong population health strategies. Continue Reading
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26 Aug 2020
How COVID-19 Affected Member Engagement in Wellness Programs
The coronavirus pandemic has impacted nearly every area of society and payers should be prepared for it to change their wellness programs as well. Continue Reading
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25 Aug 2020
Top 4 Recent Health Payer Innovative Consolidations, Partnerships
Health payers have been initiating innovative consolidations and partnerships as they manage the coronavirus pandemic’s impacts. Continue Reading
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21 Aug 2020
Payers Redesign Referral Networks for Social Determinants of Health
It is time for payers to bring community-based organizations to the table of community health and to work alongside them to strengthen referral networks. Continue Reading
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20 Aug 2020
Payers Have Various Strategies for COVID-19 Treatment Cost-Sharing
Payers on the individual health insurance market and fully-insured group market vary broadly on coronavirus treatment cost-sharing. Continue Reading
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19 Aug 2020
Aetna, Cleveland Clinic Form Low Cost, Narrow Network Health Plan
Aetna and Cleveland Clinic projected that the narrow network health plan could reduce employers’ healthcare spending by as much as 10 percent more than other Aetna plans. Continue Reading
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18 Aug 2020
How Employers Are Accelerating Virtual Care, Telehealth Adoption
Eight in ten large employers see virtual care and telehealth solutions as playing a significant role in healthcare delivery. Continue Reading
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18 Aug 2020
Payer Value-Based Care Program Ups Savings, Provider Participation
Blue Cross and Blue Shield of North Carolina’s value-based care program surpassed its year one goal of covering half of its eligible members with value-based care providers. Continue Reading
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14 Aug 2020
How Payers Use Whole Person, Palliative Care to Address Serious Illness
Payers have discovered ways to reduce the burden of severe illness through whole person and palliative care. Continue Reading
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13 Aug 2020
Rewards, Cash-Back Programs Incentivize Lower Healthcare Spending
Payers can help motivate members to pursue lower healthcare spending by rewarding them for choosing lower cost providers. Continue Reading
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12 Aug 2020
Empowering Member Decision-Making in Chronic Disease Prevention
Blue Shield of California’s new partnership aims to support member decision-making by offering easy access to medical professionals and peer support. Continue Reading
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06 Aug 2020
Key Payer Strategies to Improve Colorectal Cancer Preventive Care
By spreading awareness, increasing screenings, and broadening access to virtual care, telehealth, and at-home testing kits, payers can improve colorectal cancer preventive care. Continue Reading
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30 Jul 2020
Commercial High Deductible Plans May Not Impact Member Outcomes
Commercial high deductible plans may not have the same negative impact on member outcomes than has been recorded in past research. Continue Reading
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28 Jul 2020
Payers See Low Employer Satisfaction, Provide Limited Support
Cigna received the highest employer satisfaction score, while employers largely say payers are not responsive, transparent, supportive of payment reform, or willing to prioritize value. Continue Reading
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24 Jul 2020
How Employers, Payers Can Partner through the Workplace Transition
Payers have an instrumental role to play in the workplace transition back to the office, including helping employers offer mental and behavioral healthcare resources. Continue Reading
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21 Jul 2020
Digital Wellness Program Saw High Member Engagement After COVID-19
Blue Shield of California’s member engagement with its wellness program during the pandemic soared ten times its level of engagement before the coronavirus outbreak. Continue Reading
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20 Jul 2020
Supporting Safety Net Providers Through Value-Based Payments
L.A. Care is supporting its safety-net providers during the pandemic through early payouts of value-based contracts and close partnerships with frontline workers. Continue Reading
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17 Jul 2020
How to Manage Chronic Disease Through Technology, Member Trust
By leveraging existing technologies and helping members feel like they are not being judged, payers can more effectively empower members to manage chronic disease. Continue Reading
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16 Jul 2020
Consumers Prioritize Broad Networks, Keeping Current Provider
Consumers were willing to pay the same amount for a health plan that let them keep their own provider as they were for one that had a 39 percent broader network. Continue Reading
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15 Jul 2020
Payers Can Use Telehealth to Increase Convenience for Members
Convenience—particularly through telehealth—has become a major priority for consumers, along with price transparency, and mental and behavioral healthcare services. Continue Reading
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08 Jul 2020
What Types of Health Plans Enroll More Seriously Ill Members?
By developing a greater understanding of seriously ill populations, payers and policymakers can more accurately target their population health management strategies. Continue Reading
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07 Jul 2020
What is the Medical Loss Ratio of the Affordable Care Act?
The medical loss ratio—also known as the 80/20 rule, the medical loss trend, and the medical cost ratio—aims to ensure that payers invest in member quality of care. Continue Reading
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06 Jul 2020
5 Ways Payers Can Improve Quality Measures for Chronic Members
Quality measures could take a dive that may highly impact members with chronic diseases, but health plans can take steps to prevent this outcome. Continue Reading
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02 Jul 2020
6 COVID-19 Social Determinants of Health Payers Pivoted to Meet
In light of rapidly changing times, payers are adapting old strategies to service new challenges in addressing certain social determinants of health. Continue Reading
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30 Jun 2020
Payers Continue to Expand Value-Based Contracting Despite COVID-19
While value-based contracting was expected to stall during the pandemic, some payers see value-based care models as a lifesaver for independent provider partners. Continue Reading
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26 Jun 2020
Top Chronic Diseases Behind Payer Spending And How to Prevent Them
Chronic diseases are a source of high payer spending, but payers can implement preventive care strategies to lower their expenses and maintain positive patient outcomes. Continue Reading
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18 Jun 2020
CMS Proposed Rule Redefines Payer Value-Based Payment Negotiations
The proposed rule makes significant changes to payer value-based payment negotiations including allowing for more long term value-based contracting. Continue Reading
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15 Jun 2020
Zero-Dollar Drug Copays Lowered Total Chronic Disease Spending
Total chronic disease spending may decrease if value-based insurance designs eliminate copays for a comprehensive range of drugs for multiple chronic diseases. Continue Reading
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10 Jun 2020
Pros and Cons of Prior Authorization for Value-Based Contracting
Across the healthcare industry, stakeholders have voiced various views on the advantages and disadvantages of prior authorizations for value-based contracting initiatives. Continue Reading
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08 Jun 2020
Addressing Social Determinants of Health Requires Population-Based Data
Community Health Plan Washington is leveraging population health management tools across its community health centers to better address patient social determinants of health. Continue Reading
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20 May 2020
8 Ways Payers Can Support Provider Partners During Coronavirus
By supporting providers in these eight ways, payers can meet their provider partners’ financial, professional, and personal needs during coronavirus. Continue Reading
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07 May 2020
Providers Report Low Levels of Trust in Healthcare Payers
Providers limited trust in their healthcare payer partners is likely linked to their low level of communication, according to Insights by Xtelligent Healthcare Media’s recent survey of providers. Continue Reading
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09 Apr 2020
Building Payer-Provider Partnerships for Bundled Payment Models
BCBSRI and University Orthopedics partnered to deliver bundled payment models for hip and knee replacements, highlighting a push towards more value-based reimbursement and holistic care. Continue Reading
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27 Mar 2020
Value-Based Care Assessment Calls for Payer-Provider Collaboration
Payers and providers must align their definitions of value and communicate more effectively to succeed in value-based care, according to Xtelligent Healthcare Media’s recent Value-Based Care Assessment. Continue Reading
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20 Mar 2020
How Payers Invest in Coronavirus Social Determinants of Health
Payers are investing in the coronavirus social determinants of health, such as food instability, as an additional prevention method. Continue Reading
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06 Mar 2020
Challenges in Adopting a State-Based Health Insurance Marketplace
States look to launch a state-based health insurance marketplace to save money and gain control, but experts warn about the challenges associated with adoption. Continue Reading
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05 Mar 2020
Analysis of Claims Data Shows 200% Spike in Alzheimer’s, Dementia
A new report finds that 37,000 commercially insured Americans aged 30 to 64 were diagnosed with Alzheimer’s disease in 2017, a 131 percent increase from 2013. Continue Reading
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04 Mar 2020
National Hepatitis C Screening Rate Low Despite Widespread Need
Hepatitis C has gained so much ground that the US Preventive Services Task Force recommends that all patients be screened, but most payers fail to cover it. Continue Reading
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27 Feb 2020
Implementing Value-Based Reimbursement in Behavioral Healthcare
BlueCross BlueShield Western New York’s value-based reimbursement model will bring upside risk to behavioral healthcare. Continue Reading
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26 Feb 2020
Payer Extends Value-Based Contracting to Dental Provider Group
Blue Cross Blue Shield of Massachusetts used its Alternative Quality Contract as the basis for its new dental value-based contracting arrangement. Continue Reading
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25 Feb 2020
Using Value-Based Care to Tackle Maternal Health Disparities
The model furthers value-based care by building on payer-provider partnerships and focusing on patient outcomes to decrease maternal care disparities. Continue Reading
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18 Feb 2020
Integrated Care Reduces Hospital Stays for Medicaid Children
Integrated care management programs targeted toward children enrolled in Medicaid is associated with a decrease in hospital admission, a new study finds. Continue Reading
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13 Feb 2020
Out-of-Pocket Costs for Supplemental Coverage a Problem for MA
Medicare Advantage is filling a gap in dental, vision, and hearing coverage, but research shows that members still face excessive out-of-pocket costs. Continue Reading
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13 Feb 2020
4 SDOH Barriers Payers Can Address to Drive Access to Care
By tackling these four social determinants of health, payers can improve their members’ access to care. Continue Reading
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10 Feb 2020
Payer Consumerism Strategies Rely On Data, SDOH, Simpler Language
Payer consumerism strategies are fortified by sharing information, focusing on social determinants of health, and using simpler language in consumer interactions. Continue Reading
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07 Feb 2020
3 Ways Payers Drive Population Health Management in Cancer Care
Population health management strategies such as precision medicine, coordinated care, and value-based payment models can improve patient outcomes. Continue Reading
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03 Feb 2020
Members Won’t Back Healthcare Price Transparency If Costs Go Up
3 in 4 adults would not support a federal healthcare price transparency rule if it led to higher costs, but most still want access to more information, a new survey finds. Continue Reading
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31 Jan 2020
Humana Foundation Allots $7.6M to Social Determinants of Health
The investment will address social determinants of health in 8 communities across southeastern US and focus on enhancing quality of care for local residents. Continue Reading
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30 Jan 2020
BCBS NC, Quartet Partner to Implement Value-Based Payment Model
The new value-based payment model intends to better compensate providers and enhance quality of care for patients with mental health issues. Continue Reading
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29 Jan 2020
How UPMC Coordinates Compounding Social Determinants of Health
UPMC’s Social Impact Initiative consolidates social determinants of health programs to better coordinate services and improve member’s health outcomes. Continue Reading
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29 Jan 2020
How Payer-Provider Relationship Enables Value-Based Care Success
The payer-provider relationship is historically an adversarial one, but emerging care delivery and payment models require the two groups to let down their guards to improve patient outcomes and reduce costs Continue Reading
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24 Jan 2020
Finalized CMS Rule Supports Medicare Coverage for Acupuncture
The finalized rule provides Medicare coverage for patients who require acupuncture and expands CMS’ previous efforts to tackle the nationwide opioid crisis. Continue Reading
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16 Jan 2020
How Payers Can Help Reform Behavioral, Mental Health Parity
Experts from the Bowman Family Foundation and the National Alliance of Healthcare Purchaser Coalitions explain how payers can assist with behavioral and mental healthcare parity. Continue Reading
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14 Jan 2020
AHIP Signs onto Support for Social Determinants Accelerator Act
The Social Determinants Accelerator Act would assist social determinants of health initiatives across the nation and establish a social determinants council. Continue Reading
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10 Jan 2020
How Medicare Advantage Is Leading Payers to Adopt Value-Based Care
The transition to value-based care has stalled, but the unique structure of Medicare Advantage can help payers advance to lower costs and better outcomes. Continue Reading
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09 Jan 2020
How Medical Rideshare Deals in Medicare Drive Quality Outcomes
Alignment Healthcare’s Uber Health partnership connects Medicare members to transportation services for medical appointments, reducing emergency room visits and cancellations. Continue Reading
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08 Jan 2020
High-Deductible Health Plans Spur Maternity Out-of-Pocket Spending
Women’s maternity out-of-pocket spending is escalating in part because of high deductibles brought on by a lack of cost-sharing restrictions. Continue Reading
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02 Jan 2020
Data Sharing, Teamwork Essential to Pediatric Value-Based Care
Horizon BCBSNJ’s 2018 care results indicate that data sharing and teamwork between payers and providers help improve outcomes in pediatric value-based care. Continue Reading
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24 Dec 2019
Building Cross-Sector Partnerships to Address Food Insecurity
Centene and Feeding America’s program to create best practices for medically tailored boxes demonstrates the importance of cross-sector partnerships in addressing food insecurity. Continue Reading
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09 Dec 2019
Value-Based Reimbursements Hit 53% in 2017, Reform Slows
Over half of payments made to providers in 2017 were value-based reimbursements, but payment reform overall is slowing down. Continue Reading
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21 Nov 2019
Why the Future of Value-Based Care Begins with Children's Health
Transforming the way children’s health is delivered and paid for will fundamentally shift healthcare towards value. Continue Reading
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18 Nov 2019
Accessible Data, In-Person Dialogue Key to Value-Based Partnerships
Payers and providers discussed accessibility and the benefits of in-person dialogue for value-based partnerships at Xtelligent Healthcare Media’s Fourth Value-Based Care Summit. Continue Reading
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12 Nov 2019
Community Health Workers Fill Gaps in Rural Healthcare
Leveraging community health workers in rural settings can help fill gaps in care and provide needed interventions to vulnerable populations. Continue Reading
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12 Nov 2019
Eliminating Waste, Promoting Value Across the Health System
Nearly one-quarter of all healthcare spending in the United States is wasteful. Removing waste and promoting value in healthcare will require tools that empower physicians and support shared decision-making. Continue Reading
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11 Nov 2019
Strategies for Managing Chronic Conditions in Rural Areas
Chronic diseases disproportionally affect individuals in rural areas. To help manage these and minimize the negative health impacts they have on individuals, local organizations are investing in multiple strategies. Continue Reading
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07 Nov 2019
Payer-Provider Partnership, Data Management Promote Population Health
Strong payer-provider partnerships allow for improved data management that fuels population health and enables success in value-based care models. Continue Reading
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04 Nov 2019
Strategies to Improve Payer-Provider Relationship, Data Quality
The 4th Annual Value-Based Care Summit brought together payers and providers to discuss the challenges of value-based care and provide proven strategies for improving payer-provider relationships that allow these models to thrive. Continue Reading