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.

News 04 Nov 2019

Health Payers Tap Telehealth to Boost Pediatric Psychiatry Access

When the demand for children’s psychiatry services was high but the state suffered pediatric psychiatrist shortages, BCBSRI leveraged telehealth options and a strong provider relationship. Continue Reading
News 09 Oct 2019

3 Strategies for Payers to Improve Member Medication Adherence

Payers have a significant role to play in enabling members’ medication adherence through diminished copays, mobile messaging, and real-time prescribing information. Continue Reading
News 07 Oct 2019

How Quality Fits into Value-Based Care, Organizational Improvement

Quality is an innate feature in value-based care models, but successful value-based care models utilize quality metrics that satisfy the provider, payer, and patient. Continue Reading
News 25 Sep 2019

Large Employers Focused on Quality and Variety for Open Enrollment

Large employers’ health plan decisions for open enrollment reveal six trends that will affect the quality and employees’ healthcare options in 2020. Continue Reading
Answer 09 Sep 2019

Optima Health’s Medicaid Addresses Food Security, Social Determinants

Optima Health collaborates with Solutran’s Healthy Savings program to lower financial barriers to healthy food options, increase food security and address other social determinants of health. Continue Reading
News 28 Aug 2019

Blue Cross Minnesota Announces $0 Insulin Copay, More Access to Care

The $0 copay for insulin, which will start in 2020, will improve access to care for commercial, fully-insured diabetic members. Continue Reading
Answer 16 Aug 2019

5 Strategies for 5 Stars: Cigna's Approach to CMS Star Ratings

An organization-wide commitment to focus on patient experience, preventive health, care coordination, and customer service is leading to star rating success at Cigna. Continue Reading
News 13 Aug 2019

How Payers Transition from Reactive to Preventive Care

As the industry continues to shift toward preventive care, payers are using community intervention, community activation, screenings, and technology to pursue more holistic care. Continue Reading
News 10 Jul 2019

Taking a Personalized, Digital Approach to Wellness Programs

Blue Shield California is taking a new approach to wellness programs to cater to healthcare consumerism and digital innovation in healthcare. Continue Reading
News 09 Jul 2019

CMS OKs Subscription Model in LA to Lower Hepatitis C Drug Costs

Louisiana aims to decrease hepatitis C costs with a newly approved subscription model that allows the state to purchase an unlimited amount of hepatitis C drugs and pay a fixed amount over a period of time. Continue Reading
News 02 Jul 2019

UnitedHealthcare Launches Hearing Healthcare Program

UnitedHealthcare will address hearing healthcare by partnering with two hearing aid vendors and a non-profit to increase access to affordable devices. Continue Reading
News 27 Jun 2019

Driven by Prices, Medical Cost Trend Increases 6%

The medical cost trend continues to rise due to drug spending, chronic disease prevalence, and interest in mental health services. Continue Reading
News 19 Jun 2019

Primary Care Physicians Influence LVC Spending, Studies Show

Strategies for decreasing low-value care expenditures should focus on primary care physicians’ healthcare spending. Continue Reading
News 17 Jun 2019

Existing and Emerging Technologies to Advance Value-Based Care

Technology exists to serve today’s value-based care models, but new functionalities and capabilities are necessary to advance care models based on outcomes and cost. Continue Reading
News 13 Jun 2019

CMS Approves WA Value-Based Purchasing Plan for Hepatitis C Drugs

Washington will be able to develop value-based purchasing models with drug manufacturers to implement a “subscription” model for hepatitis C drugs. Continue Reading
Answer 16 May 2019

Using Medically-Tailored Meals to Boost Chronic Disease Care

At Health Partners Plans, a medically-tailored meal delivery program is improving outcomes and reducing costs for members with chronic disease. Continue Reading
News 29 Aug 2018

How Capitated Payments Prompt Payer, Provider Innovation

Capitated payments rely on strict reimbursement guidelines that help payers cut back on their costs and promote value-based care solutions. Continue Reading
News 21 Aug 2018

Anthem, Walmart Partner for Over-the-Counter Drug Allowance

A partnership between Anthem and Walmart will give Medicare Advantage beneficiaries a new benefit to pay for over-the-counter drugs and other health items. Continue Reading
News 26 Mar 2018

Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade

Private payers experienced significant growth in urgent care center utilization from 2007 to 2016. Continue Reading
News 09 Jan 2018

Top 10 Highest Performing Commercial Health Plans

The highest performing commercial health plans for the 2017-18 plan year invested in consumer satisfaction, preventive care, and chronic disease management. Continue Reading
News 28 Dec 2017

How Process, Outcome Measures Contribute to Population Health

The use of process and outcome measures allows payers analyze care quality and support population health initiatives. Continue Reading
News 29 Aug 2017

How Preventive Healthcare Services Reduce Spending for Payers

Payers that integrate enhanced preventive healthcare services into coverage offerings can cut spending on unnecessary healthcare utilization. Continue Reading
News 30 Jan 2017

Are Bundled Payment Models or Capitation the Better Choice?

Healthcare payers will need to consider the risks of capitation payment and bundled payment models when deciding which reimbursement structure to implement. Continue Reading
News 11 Jan 2017

Prospective vs. Retrospective Healthcare Bundled Payment Models

When moving into value-based care reimbursement, payers will need to understand the difference between prospective and retrospective healthcare bundled payment models. Continue Reading
Answer 02 Dec 2016

Key Steps for Payer Success in Accountable Care Organizations

When accountable care organizations strive to improve patient engagement, population health management, and data sharing, greater success can be achieved. Continue Reading
Answer 17 Oct 2016

Private Payers Follow CMS Lead, Adopt Value-Based Care Payment

Value-based care payment contracts are becoming a mainstay of the healthcare industry from federal agencies to providers and commercial payers. Continue Reading
Answer 11 Jul 2016

How Payers Should Prepare for Value-Based Reimbursement

Payers and providers taking on value-based reimbursement arrangements must work towards reducing rates of hospital readmissions, hospital-acquired infections, and length of stay. Continue Reading
Answer 29 Jun 2016

How Quality Metrics Affect Value-Based Care Reimbursement

When negotiating contracts based on a value-based care reimbursement model, healthcare providers will need to bring more focus toward population health management and meet quality performance benchmarks. Continue Reading
Answer 16 Jun 2016

How to Overcome the Challenges of Bundled Payment Models

Physicians may find bundled payments a challenging form of reimbursement since there may be costs associated with a patient’s treatment that are out of their control. Continue Reading
Answer 03 Jun 2016

What Are the Benefits of Accountable Care Organizations?

Value-based care payment stimulates more preventive care and a reduction of hospital stays as well as emergency room visits. Continue Reading
Answer 17 Feb 2016

Time, Commitment Required for ACO, Value-Based Care Success

Accountable care partnerships will need to have greater patience when it comes to earning shared savings. Continue Reading
News 01 Dec 2015

Challenges, Advantages of Merit-Based Incentive Payment System

While the Merit-Based Incentive Payment System clearly has benefits for the Medicare program, there are substantial challenges standing in the way of this program. Continue Reading
News 30 Nov 2015

Top 3 Ways to Meet HEDIS Quality Measures, Improve Performance

Currently, more than 90 percent of health plans use HEDIS to determine their overall performance when it comes to serving their consumer base. Continue Reading
News 19 Nov 2015

The Role ACOs Play in Propelling Population Health Management

With more financial incentives coming from the federal government to reduce hospital readmission rates, healthcare providers including hospitals and ACOs are pursuing population health management strategies. Continue Reading
News 16 Nov 2015

Maryland’s All-Payer Model Shows Promising First Year Results

The first year quality results from Maryland’s All-Payer Model show the real advantages of this payment system, as the composite quality measures for preventing disease strengthened by more than 26 percent. Continue Reading