Healthcare Reform

The healthcare industry is evolving right before our eyes. It’s no longer running primarily on the old fee-for-service incentive models and is making the switch to the much more efficient, value-based care model. In this new value-based care model, the emphasis is placed on quality of care and patient satisfaction. If healthcare organizations hope to thrive in this new world, they need to have a robust outcome improvement program in place.

There is good news for both cancer patients and health care providers alike; the new Oncology Care Model introduced by CMS will promote value-based care from now on, rather than the old payment structures for cancer care providers, which rewarded quantity over quality. Starting July 1, 2016, over two hundred different physicians and seventeen insurance companies have been chosen to take part in the new Oncology Care Model. The model will run all the way through June 30, 2021, and health care providers participating in it will be able to assume financial risk, should they choose to do so, as soon as 2018.

More physicians are looking to shake things up or get out of the business altogether as new regulations and payment models are in effect. 46% are planning to accelerate their retirement, cut back on patients, or swap out their position for less involved “non-clinical roles.” That’s according to the 2016 Biennial Physician Survey, published last September by the Physicians Foundation.

As of August 1st, 2016, the CMS now includes 14 more regions to participate in the Comprehensive Primary Care Plus. Also known as CPC+, this new payment plan is a primary care model that allows for easier payments and quality care. This all-new revolutionary structure of medical care is more accessible than ever. Doctors and patients alike can both reap the benefits of this program, and its availability is spread further by the year.

On October 14, 2016, the Center for Medicare and Medicaid Services (CMS), released its final rule on MACRA (or the Medicare Access and CHIP Reauthorization Act), effectively changing the reimbursement system used in Medicare. The purpose of this shift is to incentivize and pay physicians for providing higher quality care. Within this new law, eligible healthcare providers have the option to choose between two different paths for the program: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models...

As the Centers for Medicare and Medicaid Services (CMS) pushes forward in the shift towards value-based care payment models, private insurance companies are starting to follow their lead. A value-based care payment system is the new alternative to a fee-for-service payment system. Healthcare systems currently operate under the fee-for-service payment model, in which payers simply pay a fixed price for each of the services a physician provides. The fee-for-service model incentivizes healthcare providers to add on as many services as they...

Among the topics covered at the 2016 Health Datapalooza conference, value-based care was among those that received significant attention – a fact that is not surprising given the anticipation surrounding the Centers for Medicare and Medicaid Services (CMS) January 1, 2017 launch of the Medicare Access and CHIP Reauthorization Act (MACRA). Medicare's new Quality Payment Program came about through placing CMS employees into the field to observe physician practices surrounding quality care. However, gathering data on quality metrics through observation...

After a patient has had joint replacement surgery, the first few days at home are the most challenging. The lack of mobility means they are entirely dependent on others for basic tasks. Recognizing that quality continued care extends beyond the operating room and into the recovery period, the Centers for Medicare and Medicaid Services (CMS) has introduced comprehensive care for joint replacement (CJR)--a new initiative offering extensive and comprehensive care for joint replacement patients, aligning with the move towards value-based...

The Centers for Medicare and Medicaid Services (CMS) is looking for a new way to deliver medical services in an effort to provide more effective health care management in the public and private sectors. Hoping to persuade members of the medical community to get on board with this new push, CMS has launched Comprehensive Primary Care Plus (CPC+) as part of the initiative to improve primary care practices as it relates to patient care management services. By offering a choice between...