Value-based care has been heralded as the future of healthcare for more than a decade, but it has yet to fully arrive.

This gap is particularly evident in primary care, which must be on board if the promise of value-based care (VBC) is to be achieved. The Commonwealth Fund, a private U.S. foundation dedicated to improving healthcare, recently issued a report exploring why primary care has been so slow to adopt VBC.

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.

By Leslie Lotano-Saba RPh, MS

With the release of the second round of guidance for the Centers for Medicare & Medicaid Services’ Medicare Prescription Payment Plan (MPPP), healthcare industry companies and vendors now have a much clearer understanding of how the changes will affect operations and operating margins.

By Theresa Hush, CEO and Founder of Roji Health Intelligence

Buckle your seat belt. Health care is changing at warp speed. The Value-Based Care movement and leaps in technology and Artificial Intelligence are rapidly generating advances that will transform the health care environment. These factors will redefine health care providers and services, and how consumers access them. How you respond strategically will determine your survival as a health system, ACO, and health care provider.

Superior member engagement sets health plans up for Star rating success in 2024. This article shares six valuable strategies to improve member satisfaction and boost Star ratings.

By Jim Bonnette, MD, Chief Medical Officer, 86Borders

When Amazon acquired One Medical, we anticipated that we would see additional, non-traditional buyers in the primary care space. Names like CVS, Walgreens, and Walmart came to mind. CVS has already expanded outside of its traditional pharmacy role into the pharmacy benefit manager space with its acquisition of Caremark and into the insurance/payer space with its acquisition of Aetna. What these moves mean for the industry is that healthcare providers who traditionally were looking to sell to private equity/venture capitalist buyers now have a broad network of potential buyers for their practice

By Bernard J. Wolfson

Almost 2 million of California’s poorest and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program.

A first-ever statewide contracting competition to participate in the program, known as Medi-Cal, required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care.

1. Just under one-third of survey respondents said that their organizations currently use artificial intelligence (AI) or machine learning (ML).
2. Of these, about 36% are using this AI/ML for either computer-aided image detection for oncology or process/workflow improvement.
3. Another 34% are using AI/ML to suggest more impactful care options...

• Medical or dental bills that are past due or that they are unable to pay: 24%
• Medical or dental bills they are paying off over time directly to a provider: 21%
• Debt they owe to a bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills: 17%
• Medical or dental bills they have put on a credit card and are paying off over time: 17%
• Debt they owe to a family member or friend for money they borrowed to pay medical or dental bills: 10%
• Yes to any of the above: 41%