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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05 Dec 2024
5 pillars that underpin payer population health strategies
The healthcare system faces many challenges, but by focusing on these five pillars, payers can establish holistic and effective population health strategies. Continue Reading
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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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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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