Zelis’ Post

A right path to improve healthcare system.

Value based care requires you to study the data, provide the right tools and incentives…to get to the right outcomes.

The more experience we have in #valuebasedcare the more we find that aligned incentives between payers and providers lead to a better healthcare system in so many different priority areas, including #healthequity.

Stay ahead in healthcare equity strategy. Hear from experts Allison Combs, MS, MBA, SMP, Mitch Collier, and Ian Strayer in a Wolters Kluwer -sponsored SmartBrief webinar on #payer strategies for the #CMS #HealthEquity Index. Learn about personalized solutions, collaboration, and preparing for impactful health outcomes. https://ow.ly/MhXm50Ryyil #STARratings #memberexperience #QualityImprovement

Last week, the U.S. Department of Health and Human Services (HHS) released a proposed rule aimed at improving health information sharing and interoperability, including criteria to support the Centers for Medicare & Medicaid Services' January 2024 Interoperability and Prior Authorization final rule. The HTI-2 rule sets new certification criteria for health IT, boosting public health response and advancing value-based care. This is a step forward in making prior auths more efficient and patient centered. Learn more here: https://hubs.la/Q02GCYD10

We know patients who see clinicians in value-based care arrangements are more likely to receive higher quality care and have better outcomes. The alignment of financial incentives with improving health outcomes allows care teams to holistically address their patients' medical, behavioral and social needs, and can even reduce health disparities. No one knows this better than my colleague J. Nwando Olayiwola, a strong champion for value-based care. See her latest comments on the potential for value-based care to improve health equity in the latest Becker's Payer Issues. #Humana #CenterWell Senior Primary Care

In my latest blog post, I delve into the nuances of the "States Advancing All-Payer Health Equity Approaches and Development (AHEAD)” Model recently introduced by CMS. While it's positioned as a relatively fresh approach to healthcare equity and cost containment, there's more beneath the surface. Just days before the AHEAD model was announced, a JAMA study was released highlighting potential challenges and negative impacts of vertical integrations in healthcare: - integrations have shown a trend of guiding more patients towards larger health systems, pushing up healthcare expenses. - the increase in costs have not correlated with better care outcomes or better care. The AHEAD model, while full of promise, emphasizes global budgets and reserves a substantial role for hospitals in controlling costs through a total cost of care approach. Surely CMS must know that this approach will likely lead to greater proliferation of the vertical relationships that the JAMA study cautions against. The American Hospital Association seems keen on global budgets, so long as CMS takes a more lax approach to oversight and accountability of the systems. The AHEAD model deserves our attention and perhaps a touch of optimism. But it's equally important to approach with an informed perspective and a bit of skepticism. Dive deeper into my blog for the full scoop! Jeffrey Hoganjeff lestonDawn AlleyLee LewisCora OpsahlMisha SharpTunde CapizziDarren FogartyDarrell Moon Preston AlexanderMarshall AllenMarilyn BartlettAlex Jung Hunter Kellett #AHEADModel #HealthcareInsights #JAMAStudy

The results from our Advanced Primary Care Measurement Pilot highlight several necessary improvements to the California health care system, including an increase in data sharing and more alignment across payers to strengthen primary care teams. Learn more about these improvements and the resources needed from a recent CQC webinar about the pilot results:

Healthcare leaders: Join my colleague, Tammy Schaeffer at the Modern Healthcare webinar sponsored by Plante Moran on March 12. Gain insight into value-based care, the tools you need to succeed, and the ins and outs of risk arrangements and value-based care reimbursement. Register here. #valuebasedcare #healthcare #webinar

Alliance for Connected Care member Cadence was highlighted in Inside Health Policy! RPM Company Calls On Congress, CMS To Invest In Digital Health One of the country’s largest remote physiological monitoring service providers, Cadence, is calling on US Congress to up Centers for Medicare & Medicaid Services reimbursement levels for remote monitoring to allow expansion in rural areas and to give the agency resources to measure digital health outcomes. Read the full article here (subscription required): https://lnkd.in/gEw3xriq #remotepatientmonitoring #remotemonitoring #healthpolicy #healthcare #rural #RPM #digitalhealth #ruralhealth