Medscape and Healthcare Information and Management Systems Society (HIMSS) announced the release of their joint research, "Early Successes, Untapped Potential, Lingering Questions: Medscape & HIMSS AI Adoption in Healthcare Report 2024." The survey examines the current use and future expectations of artificial intelligence (AI) in healthcare settings. Key findings from the report reveal that right now AI in healthcare is primarily used for administrative tasks, while more clinical applications are still in the early stages of adoption. While the report's findings suggest AI's integration into healthcare is progressing, a significant skills gap could develop.

Paragon Health Institute has released a report on artificial intelligence in healthcare, "Healthcare AI Regulation: Guidelines for Maintaining Public Protections & Innovation". This paper illuminates the complexities of AI regulation in healthcare and then proposes guidelines that balance public protections with the need for healthcare innovation. Among the more noteworthy proposals is the recommendation that AI regulation must specify both the type of AI technology and the healthcare context to which each rule applies.

We continue to see an accelerating shift away from the traditional fee-for-service (FFS) model in the U.S. healthcare system toward value-based care (VBC) models. Successful VBC programs have a proven track record of improving care quality and outcomes while reducing costs. However, participation requires taking on clinical and financial risks, which is new for many venturing into value-based care. There's also resistance to leaving the “comfort zone” of FFS and learning a completely new way of doing business. So, although the benefits of VBC are clear, making a system-wide shift to VBC is hard.

With nearly 90% of the annual healthcare expenditure attributed to managing and treating chronic diseases and mental health conditions, according to the CDC, it is vital to prioritize models of care that deliver effective whole-person care. Value-based care (VBC) represents a transformative shift in economic models that is designed to deliver improved health outcomes for patients by tying reimbursement to clinical effectiveness rather than to the volume of services rendered.

New policies tucked into the Centers for Medicare and Medicaid Services’ (CMS) 2025 Medicare Physician Fee Schedule Rule (Final Rule) will likely spur increased Accountable Care Organization (ACO) participation in the Medicare Shared Savings Program (MSSP or Program), in part due to the potential for ACOs to earn more savings and access savings sooner. The Final Rule, effective January 1, 2025, establishes a new prepaid shared savings option, expands the set of primary care services that trigger beneficiary alignment, creates a health equity benchmark adjustment, and institutes a new process to adjust financial calculations for improper payments outside of an ACO’s control.

Primary care practices are facing a significant shift as the Centers for Medicare & Medicaid Services (CMS) continues to push toward its goal that all Medicare beneficiaries be under a value-based contract by 2030. Moreover, providers are faced with constant challenges in maintaining sustainable practices with ever-increasing administrative burdens, staff shortages and increasing operational costs. This has prompted a surge in interest among providers to join an accountable care organization (ACO) to access shared savings via new payment models. However, the crucial decision of which ACO to join requires careful consideration of various factors. 

A new report says health inequalities have, in essence, created 10 Americas. "The extent and magnitude of health disparities in American society are truly alarming in a country with the wealth and resources of the USA," said Christopher Murray, director of the University of Washington's Institute for Health Metrics and Evaluation. "These disparities reflect the unequal and unjust distribution of resources and opportunities that have profound consequences on well-being and longevity, especially in marginalized populations."

In recent years, there has been a growing focus on addressing health disparities and advancing health equity. While the federal government can play a key role in addressing inequities, states also play a pivotal role, as they set policies, allocate resources, and administer many services and programs that are important for addressing the conditions that determine health both within and beyond the health care system. Moreover, states have varying demographics, population needs, and political leadership, which may shape efforts to address health disparities and promote health equity.

This chart collection explores how health spending is expected to grow in coming years, based on National Health Expenditure (NHE) projections from federal actuaries. A related chart collection explores how U.S. health spending has changed over time using historical data, and an interactive tool allows users to explore health spending changes over time.

By Henry Osowski

We have witnessed some challenging environments over the last two decades, but none as challenging as the current landscape for Medicare Advantage plans. Five months into 2024 the environment is displaying troubling signs of the challenges ahead. With the release of enrollment data for the last AEP many well-known plan sponsors experienced little or no growth. A few plans even saw significant loss of membership. Increasing medical loss ratios put even more pressure on financial results. Capping the bad news came with the release by CMS of the “Final Rule” for 2025.