Blog

Healthcare delivery has traditionally reimbursed providers on a fee-for-service (FFS) basis. This reimbursement system incentivizes volume over quality and leads to unsustainable growth in healthcare costs. In an effort to contain costs and reform the healthcare delivery system to prioritize value over volume, CMMI and commercial payers have introduced a multitude of value-based payment (VBP) […]

Expanded access to claims, EMR, ADT (Admission, Discharge and Transfer information), health related social need and other health care data sources through maturing health information exchanges, integration solutions and other avenues is creating new opportunities for both providers and payers. At the same time the volume of data available and diversity of data sources can […]

Over the course of the past decade, as more practices have entered the arena of Value-Based Care, practice operational functions have increasingly become an after-thought. The promise of big bonus checks (real or imagined) has created an environment in which small and mid-sized practices have shifted their focus toward RAF, gap closure activity, quality indicator […]

As we write to you in May 2024, the first cohort application dates have passed and the third in August remains. Our team highlights key considerations for hospitals below: 1. Hospitals Should Monitor Whether Their State Applied for Cohorts 1 & 2 or Intend to Apply for Cohort 3: Applications for the first two […]

As CalAIM continues through year three of implementation, Enhanced Care Management (ECM), Community Health Workers (CHWs) and Community Supports (CS) continue to scale. These services are increasing integration with primary care provider organizations, whether an in-house service, contracted or a referral partner, who are ultimately accountable to managed care plans (MCPs) and the State for […]

Background: Federally Qualified Health Centers (FQHCs) are designated entities in the national Health Center Program that are instrumental in providing healthcare services to underserved communities and increasing access to high quality, affordable healthcare. The fee for service model does not reimburse most providers at an adequate level to be sustainable with the growing Medicaid […]

Community Health Workers (CHWs), also referred to as Promotores, are community-based frontline health workers experienced in providing linguistic and culturally sensitive, individualized whole person care in both clinical and non-clinical environments. CHWs can enhance access to and quality of primary care and are often underutilized due to a lack of understanding of their capabilities and […]

At the end of February, the Millbank Memorial Fund released their 2024 primary care scorecard entitled ‘No One Can See You Now’. A bleak assessment of primary care in the United States, the scorecard identifies five key contributors to the ever-worsening patient access crisis, the top two of which cite the need for workforce expansion1: […]

Value-based contracts offer provider organizations an opportunity to govern themselves in order to provide high-quality, cost-efficient care to their attributed members and take responsibility for determining the most efficient and effective use of healthcare resources. Much has been written on what a value-based contract is, what is included in a value-based contract, how to negotiate […]

Recently we shared key considerations for organizations considering or planning to apply to the Medicare Shared Savings Program (MSSP), a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings by creating Accountable Care Organizations (ACOs). […]