Upperline Health’s Post

Investments in primary care are known to meaningfully shape patient outcomes and are often associated with lower health care costs and higher quality care. To better understand the system-wide investments in these areas, CHIA published its latest report examining spending on primary care services in Massachusetts. Comprehensive data on expenditures for these services in the Commonwealth has been limited to date. To address this gap, CHIA collects data on payments made by health plans to health care providers delivering these services. This report focuses on spending for primary care services for members enrolled in private commercial, Medicaid MCO/ACO-A, and Medicare Advantage plans for CY 2021. This series is part of an effort by CHIA to offer policymakers and industry leaders valuable data that can be used to track the health care system’s investments in these essential services.  The report, which includes a detailed databook, can be seen on CHIA’s website at: https://lnkd.in/dxfPhkdj 

I sat down this week with Alan Weil for this Health Affairs conversation and we had a wide-ranging discussion about the #Medicare Value-Based Care strategy. We dive into alignment across payers, driving #accountablecare, promoting #healthequity, primary care, quality, and so much more. Check it out: https://lnkd.in/e_anEqHK

Sharing a terrific article from Health Affairs describing the history and evolution of the Physician Fee Schedule and why it is an overlooked and under-appreciated tool in the toolbox to help address payment distortions in US Health care. The authors argue that for all our efforts at value-based payments, we've failed to utilize all the tools at our disposal - principally the physician fee schedule that drives reimbursement for the majority of professional services in healthcare. The physician fee schedule is the ultimate reflection of the US healthcare value-system and despite a decade of talk about the #tripleaim and #valuebasedcare very little has changed in the physician fee schedule to reflect a shift toward preventive, team-based, comprehensive care. https://lnkd.in/edC3sats

Exciting News! I’m thrilled to share that our latest blog post is now live! In this post, we delve into preparing for CMS v28, we explore the key modifications, impacts on healthcare providers, and what beneficiaries need to know. Whether you're a healthcare professional, policy maker, or someone navigating CMS, you'll find valuable insights and actionable tips to stay informed. 🔗 https://lnkd.in/dFf_WwpW Here’s a sneak peek of what you can expect: - Comprehensive overview of Medicare's v28 updates - Key changes affecting healthcare providers - Essential information for beneficiaries Happy reading and I hope you find it insightful!

Keeping us up-to-date regarding the electronic sharing of our patient’s health information, especially as small Private Practice physicians. Consider joining for Small Provider Perspective: WEDI Road to Interoperability & PA Series April 8, 2024 1:00 PM - 3:30 PM (EDT) Description The Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization Final Rule (Final Rule) on Jan. 17, 2024. This final rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients, healthcare providers, and payers. This final rule also focuses on efforts to improve prior authorization processes through policies and technology, to help ensure that patients remain at the center of their own care. This interactive spotlight, part of WEDI’s Road to Interoperability Series, will offer a unique perspective on the rule’s impact on small providers. Benefits, considerations, implementation strategies, challenges and suggestions will be addressed. Time Note: End time subject to change due to content and audience participation Location A zoom link will be available on the event registration confirmation page - registration page link shared in the chat #Interoperability #PatientPrivacy #PatientData #HealthcareData #PrivatePractice #PhysicianAutonomy

Thanks Paul Nicolaus for including my thoughts in your timely & informative article! On 7/2 CMS announced CT, MD, VT will be the 1st participants. For more info, see link below. #populationhealth #value #SDOH #AHEAD

House Bill Aims To Lower Healthcare Costs, Increase Transparency The Hill (9/8, Choi) reported, “Leadership from the House Energy and Commerce, Ways and Means and Education and the Workforce committees introduced the Lower Costs, More Transparency Act, tying together numerous pieces of legislation focused on improving health care affordability.” The bill “would require hospitals to publicize the standard prices for all items and services in a readable format” and “also require upfront transparency on the cost of imaging services and laboratory testing, as well as require pharmacy benefit managers (PBM) to provide employers with spending data.” Regarding PBMs, the proposal “includes measures that would ban the practice of spread pricing in Medicaid.” https://buff.ly/3EARZeO

House Bill Aims To Lower Healthcare Costs, Increase Transparency The Hill (9/8, Choi) reported, “Leadership from the House Energy and Commerce, Ways and Means and Education and the Workforce committees introduced the Lower Costs, More Transparency Act, tying together numerous pieces of legislation focused on improving health care affordability.” The bill “would require hospitals to publicize the standard prices for all items and services in a readable format” and “also require upfront transparency on the cost of imaging services and laboratory testing, as well as require pharmacy benefit managers (PBM) to provide employers with spending data.” Regarding PBMs, the proposal “includes measures that would ban the practice of spread pricing in Medicaid.” https://buff.ly/3EARZeO

We founding this interesting: A recent blog by Health Management Associates investigates the impact of new entities assuming accountability for cost and quality of care to understand the market growth and their role in advancing accountable care in Medicare, Medicaid and the healthcare sector: https://ow.ly/Jmk850QEg8A

Humana is helping create a health care ecosystem where value-based care is the new standard of care. In 2022, 70% of their Medicare Advantage plan members were aligned with a value-based care provider. How'd that go? My The George Washington University colleague Kate Goodrich put it this way: "The data are clear. Value-based care works." I couldn't agree more. Humana's Medicare Advantage beneficiaries benefitted: ✅ Higher preventive screening rates ✅ Increased medication adherence ✅ Improved experiences ✅ 13% fewer ED visits The value-based care providers in their networks benefitted: ✅ They earned 3.4x the Medicare physician fee schedule ✅ They received a greater share of the overall health care dollar in medical claims and capitation, bonus, and surplus payments Humana itself benefitted: ✅ They generated $8 billion in cost savings ✅ They experienced improved compliance with HEDIS performance measures ✅ They lowered disparity scores on their Medicaid plans Amazing things happen when we align incentives behind patient health. Kudos to Kate and the team at Humana for taking this leap and reaping such incredible rewards for everyone involved. More: https://lnkd.in/ggFC3Kxd #valuebasedcare #valuebasedhealthcare #humana #medicare #medicareadvantage