Payment Models

State of Medicare: Some good news on program solvency still leaves questions and challenges

Medicare should remain solvent a little bit longer than previously anticipated, while a policy debate is ramping up over how to make the program sustainable for the long term. The 2023 annual report of the Medicare Boards of Trustees projects that the Hospital Insurance (HI) trust fund, which subsidizes Part A services, essentially will be…

Nick Hut April 17, 2023

Maryland’s all-inclusive population health payment model continues to show promise, but nonhospital spending poses a concern

An innovative payment model for Maryland healthcare providers has improved utilization, cost and quality thus far, but an increase in nonhospital spending requires further study. The Center for Medicare & Medicaid Innovation (CMMI) released an analysis of the first three years of Maryland’s Total Cost of Care Model, an effort to improve population health management.…

Nick Hut March 31, 2023

In federal ACO programs, advocates see signs of slow but steady progress

Growth in accountable care organization (ACO) programs has been inconsistent since the Affordable Care Act made accountable care part of the healthcare lexicon in 2010. Nonetheless, proponents are optimistic about the state of ACOs and their potential in upcoming years, even if there’s uncertainty about CMS’s ability to achieve its stated goal of ensuring every…

Nick Hut February 23, 2023

Massive federal spending bill alleviates reimbursement concerns for hospitals, but less so for physicians

Healthcare provider advocates applauded the inclusion of key reimbursement relief measures and other policies in a proposed federal spending bill for FY23, although physician groups expressed concern about the outlook for their constituents. With a divided Congress looking to muster the votes to pass the legislation before a self-imposed deadline of week’s end, the bill includes many…

Nick Hut December 20, 2022

Joe Fifer: Cost effectiveness of health: Why now?

Joe Fifer says it’s time for healthcare leaders to make a choice about their role in addressing social determinants of health and outlines three options for doing so.

Joseph J. Fifer, FHFMA, CPA August 31, 2022

HFMA’s Annual Conference: Joe Fifer calls on healthcare organizations to find ways to better address holistic health issues

Healthcare stakeholders must embrace a broader concept of health to enhance the welfare of their communities, according to a pair of talks Monday at HFMA’s Annual Conference.

Nick Hut June 27, 2022

State of Medicare: Trustees push back projected date of Part A insolvency, but issues must be addressed

Even though the Hospital Insurance Trust Fund now is expected to be depleted in 2028 instead of 2026, Medicare still faces daunting challenges.

Nick Hut June 15, 2022

Marcus Whitney: 3 healthcare innovation trends that leaders should keep an eye on

The workforce shortage, the behavioral health movement and value-based care are areas with the most momentum among early-stage investors.

Marcus Whitney March 30, 2022

Operationalizing value-based primary care: lessons from the field

The primary care physician’s office has a pivotal role to play in efforts of hospitals, payers and other healthcare stakeholders to transition healthcare payment to arrangements that reward providers for the value of the care they provide. However, to successfully execute a value-based primary care model, organizations should be mindful of the all-too-common pitfalls that they may encounter along the way.

Matthew Bates March 25, 2022

CMS’s overhaul of the Direct Contracting program draws praise from supporters of value-based payment

Value-based payment advocates see reason for optimism in CMS’s recent decision on the future of its Direct Contracting model.

Nick Hut March 4, 2022
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