Alliance for Value-Based Patient Care’s Post

Value-based care is at an inflection point, as critical alternative payment model incentives are set to expire. Alliance for Value-Based Patient Care members Susan Dentzer, president and CEO of America's Physician Groups, and Aisha T Pittman, senior vice president of government affairs of the National Association of ACOs, will join the Duke-Margolis Institute for Health Policy and West Health to discuss: ➡️ How accountable care organizations have improved patient care ➡️ Factors preventing physicians and other clinicians from transitioning to value ➡️ What policymakers and other stakeholders can do to strengthen advanced alternative payment models and reform the Medicare physician payment system Register for the event: https://bit.ly/4gGSyp2 #ValueBasedCare #Medicare #AccountableCare

Your voice matters! Find the full article at https://lnkd.in/gxy6s2wn —— In July, the Centers for Medicare and Medicaid Services (CMS) proposed rescinding the Appropriate Use Criteria (AUC) rules and policy as part of the Medicare 2024 Physician Fee Schedule (MPFS) proposed rule. This was huge. With these changes came the opportunity for feedback. The RBMA responded on behalf of its members and their comments reflected concerns about key issues in the proposed legislation. Yet, this is a complex issue and the policy could have greatly benefited from your unique perspective and expertise in radiology as well. While the comment period has passed, let this policy change serve as a reminder of the importance of comments and questions in response to proposed rule making in the future. Let your voice (and your practice's) be heard!

With news of CMS Star Rating recalculations, many Medicare Advantage plans are revisiting their supplemental benefit packages. Investing in programs that drive health outcomes, improve the member experience, and reduce total cost of care is a top priority—so let us help get you there. Driven by rigorous research, numerous studies demonstrate Papa’s clear value and ROI. Member cohorts using Papa are associated with a: 📉 19% reduction in total cost of care 🏥 20% reduction in emergency department visits 🚑 18% reduction in inpatient hospital admissions 🌟 6% higher composite care gap compliance rate, meaning Papa members attended more Stars-related screenings and appointments than matched non-Papa members. People need people, especially when it comes to their health. Discover how our core companion care solution, combined with configurable impact programs like #StarEnhancement and #SDoHNavigation, can make a significant difference for your members. 🔗 Proven Impact of Companion Care: https://bit.ly/3KkAC4H

Top Medicaid-Accepting PCP Doctors in New York Introduction: In the bustling city of New York, where the pace of life never slows, accessing quality healthcare is a priority for its residents. This guide focuses on connecting you with top Primary Care Physicians (PCPs) who accept Medicaid. Understanding the role of PCP doctors and the nuances of Medicaid in New York is crucial in making informed healthcare decisions. What is a PCP Doctor? Primary Care Physicians, commonly known as PCPs, are the first point of contact in the healthcare system. They play a pivotal role in maintaining your overall health and well-being. PCPs offer a wide range of services – from preventive care, routine checkups, and health monitoring to diagnosing and managing acute and chronic illnesses. They understand your medical history, help navigate the healthcare system, and refer you to specialists when necessary. A strong relationship with a trusted PCP is fundamental to achieving long-term health goals. https://lnkd.in/e7GmpRg2

🔍 **Understanding Medicare: Navigating the Nuances of Coverage** As healthcare professionals, we must guide our patients and clients through the intricate landscape of healthcare coverage. A recent article on Healthline delves into the various components of Medicare, elucidating the specific coverages and gaps that each part encompasses. **Key Takeaways:** 1. **Medicare Part A** focuses on inpatient care, but remember—it doesn’t cover doctor fees during hospital stays. These fees fall under **Part B**, which also includes outpatient care and preventive services. 2. **Part D** addresses prescription drug costs, with fees varying by income. Let’s not overlook how critical this is for managing long-term care for chronic conditions. 3. **Medicare Advantage (Part C)** enables personalized plan building, merging Parts A and B with additional benefits like dental and vision. These private plans may offer customizable, albeit variable, coverage options. 4. Lastly, **Medigap** provides essential support for costs not covered by Original Medicare, ensuring fewer out-of-pocket expenses for our clients. Recognizing the interplay between these parts is paramount for optimizing healthcare outcomes and financial planning. 👉 **Call to Action:** What’s been your experience with navigating Medicare's complexities? Share your insights or pose your questions—let’s foster a collaborative discussion to better serve our communities. #Healthcare #Medicare #ProfessionalDiscussion

Thank you CMS for a good Monday morning read with my cup of tea 🌞 Introducing the Transforming Episode Accountability Model (TEAM), a proposed initiative aimed at enhancing care quality and reducing costs for Traditional Medicare beneficiaries undergoing surgical procedures. TEAM fosters coordinated, high-quality care, potentially lowering rehospitalization rates and improving recovery times. 🌟Key highlights🌟 🔸TEAM builds upon previous episode-based payment models and targets specific high-expenditure, high-volume surgeries. 🔸Hospitals selected would be accountable for episode quality and cost, ensuring patient referrals to primary care services. 🔸Mandatory implementation begins January 2026, spanning five years with various risk-reward tracks. 🔸Evaluation will gauge impact on care quality, access, utilization, expenditure, and patient experience. 🔸Hospitals required to participate would be based on selected geographic regions, Core-Based Statistical Areas (CBSAs) 🔸TEAM prioritizes health equity, offering flexibilities for underserved hospitals and including a social risk adjustment in pricing methodology. Exciting times ahead as TEAM aims to revolutionize Medicare care delivery! Personally, I feel inspired seeing healthcare shift more towards this value base care approach. Anyone else? Share your thoughts below 💭 Shoutout to Patricia (Patty) Resnik, MJ, MBA, FACHE, RRT, CPHQ, CHC, CHPC for always keeping me in the loop on CMS updates ⚡Link to CMS briefing in comment below⚡ #Medicare #HealthcareInnovation #ValueBasedCare #TEAMInitiative

In healthcare we have access to better price transparency than ever before and separately insights into clinical outcomes. Wouldn't it be great if we had accurate price information associated with outcomes? Shopping for services simply based on prices has consequences as does shopping for services based on outcomes alone. As patients, we need both pieces of the equation to make good decisions. https://lnkd.in/gigHwZmG

Are you a FQHC, an RHC or do you just need the latest on CMS regulations and payment policies? Look at this article by the healthcare consulting firm Withum, which outlines all of the significant changes and effects in one neat package. Learn how CMS is broadening telehealth services, remote monitoring and mental health care for FQHCs or RHC's (medical establishments providing primary care to the poor) as well as altering P4P payment rates and billings processes. This is your chance to keep on top of things for the coming year, so don't take it as an opportunity lost.

Exciting News!! Our newest paper delves into how collaboration between health plans, PBMs, and community pharmacies can improve health outcomes and reduce costs for Medicaid members with chronic conditions. This research brings new insights into the positive impact of these partnerships. #Healthcareinnovation #Valuebasedcare #Communityhealth

If you missed this webinar discussing our most recent research with Harvard Medical School on the impact of Medicare Advantage plan design on health outcomes among various types of Medicare enrollees I am sure you will find it informative. Better still it is moderated by Susan Denzer, President of Americas Physician Groups and if you know Susan you know she always brings keen insights, perspective, and questions. Please reach out if you want to learn more about our work exploring differences between traditional Medicare and Medicare Advantage. #Medicare #MA #FFS #benefitdesign #outcomes #quality #inovalon