| “Many community-based organizations lack sustainability. It is up to payers — or the holders of the financial and outcomes risk for the individual — to create the infrastructure and processes to add CBOs to their VBC models and pay them for their services.” | ||
| -Lynn Carroll, COO and Head of Strategy, HSBlox |
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Leveraging Value-Based Provider Arrangements to Incent Reduction of Health Disparities
The Health Care Payment Learning & Action Network (LAN)'s 2021
Measurement Effort found that over 75% of plans are leveraging
value-based provider arrangements to incent the reduction of
health disparities. 58% of plans surveyed collect standardized sociodemographic data; 47% improve the quality and completeness
of sociodemographic data; and 41% measure health disparities by
stratifying along sociodemographic factors. In addition, 30%
improve patient consumer experience for targeted populations;
and 19% improve performance on measures stratified by
sociodemographic data |
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Forrester: Five Key
Predictions for the Healthcare Industry in the Coming Year 1. Finally, the full story of patient health 2. Big payers will continue to cozy-up the exchanges 3. Expect more Medicare Advantage disruptions 4. VBC will expand within its limits 5. Digitization growth through a consumer focus 6. Payers will continue to get a little closer Source: HealthLeaders: The 6 Most Important Health Plan Trends of 2022, December 27, 2021 |
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Key Health Law Developments in 2021 and What to Expect in 2022
William Horton, Partner, Jones Walker, Daniel Murphy,
Partner, Bradley Arant Boult Cummings, and Judith Waltz,
Partner, Foley & Lardner, discuss some of the key health law
developments in 2021 and what to expect in 2022. They examine
the overall state of the health care industry from a regulatory
perspective amid the continuing effects of the pandemic and the
flurry of activity from CMS and other government agencies. They
also discuss the uptick in transactional and M&A activity, the
consequences of the price transparency rule, the role of sub
regulatory guidance, and more. |
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Check out
HealthshareTV, the
home for health care videos |
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Marketplace Pulse: Participation in 2022 Enrollment in the ACA marketplace has risen to record levels, with at least 14.2 million plan selections reported ahead of the January 15th deadline, when open enrollment ends in most places. This reflects a combined total from the 33 states that use the healthcare.gov platform along with the 18 state-based marketplaces. Robert Wood Johnson Foundation, January 18, 2022 The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services Just over half of the total U.S. population receives health insurance through commercial plans that are offered by employers or purchased by individuals. In recent years, commercial health insurers’ per-person spending on hospitals’ and physicians’ services has grown more quickly than analogous spending by the Medicare fee-for-service (FFS) program, according to analysis by the Congressional Budget Office. CBO, January 2022 Blog: The Big Picture: Healthcare 2022 - Trends, Predictions Challenges & Opportunities Health brands are jumping on the transformation bandwagon. We need to change. We need to modernize. The health sector needs to reimagine itself. And needs to do it around the customer. This collection of curated factoids can help health brands not only contend with market realities, but anticipate change. Think of it as context for the futurity of today’s decisions. An opportunity to step back to assess ‘big picture’ healthcare trends to inform core enterprise planning from vision to strategy to in-market tactics. Lindsay Resnick via MCOL Blog, January 20, 2022 Full-Integration Hospital Mergers Can Improve Quality of Care, Study Finds A full-integration approach to a hospital merger was associated with quality improvements including a reduction in mortality rates, a recent research article says. Earlier research has shown that hospital consolidations have more than doubled since 2009. Other earlier research has found hospital mergers can have a negative impact on quality, including increased mortality rates associated with a reduction in hospital competition. HealthLeaders, January 17, 2022 Blog: Five Healthcare Prognosticators That Resonated for 2022 We recently provided our own view into 2022, Scrolling Through the Roadmap of 2022 Healthcare Trends, With Sixteen Selected Stops. Now we’ve scrolled even further to see what others are saying about the coming year in healthcareland. We found five recent prognosticators from different perspectives that resonated, to share with you. Clive Riddle via MCOLBlog, January 13, 2022 2021 M&A in Review: A New Phase in Healthcare Partnerships Throughout 2021, there was one consistent trend in partnership, merger, and acquisition transactions between hospitals and health systems: the number of transactions was down, but the size of transactions was up. The process of industry transformation continues as the impact on transaction activity evolves. KaufmanHall, January 10, 2022 How Payers are Linking Community-Based and Value-Based Care to Strengthen Outcomes and Equity Like politics, it's been said that all healthcare is local. But when it comes to the role of community-based organizations (CBO) in supporting health, payers and other stakeholders haven’t quite known how to include their closest neighbors. Add to this the rising importance of social determinants of health (SDOH), which CBOs may be qualified to identify and meet but also disadvantaged to address from a healthcare system perspective, including value-based arrangements. HealthLeaders, January 6, 2022 Managed care can help states address health equity. Here's how states are taking advantage of the option Medicaid managed care has the potential to help states address social determinants of health by expanding coverage of value-based services, according to a new report. The report was put out by Together for Better Medicaid and Health Management Associates (HMA). The analysis reviewed 10 recent state requests for proposals, from 2020 and 2021, and revealed that state Medicaid agencies are increasingly committed to addressing SDOH and health equity. FierceHealthcare, December 16, 2021 |
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CVS Health and Uber Health partner on free
medical transportation to reduce barriers to care FierceCVS Health is continuing its tread on the path to health equity with a new partnership with Uber Health. The collaboration, part of the pharmacy giant’s Health Zones initiative, will give people in underserved communities free rides to medical care, work or education. Fierce Healthcare, January 20, 2022 COVID-19 Federal Spending Drove National 2020 Healthcare Spending National healthcare spending increased by nearly 10 percent in 2020 to $4.1 trillion, largely due to the spike in federal spending in response to the COVID-19 pandemic, according to a Health Affairs report. When the pandemic hit in March 2020, it jumpstarted a series of changes in the healthcare industry. Health systems and clinics shut down, Americans delayed receiving healthcare services, health insurance coverage shifted due to unemployment, and the federal government increased its spending to support COVID-19-related actions. HealthPayerIntelligence, January 17, 2022 ACA signups blow past 14M as Saturday deadline for open enrollment looms More than 14.2 million people have bought a plan on the Affordable Care Act’s insurance exchanges as of Jan. 8, as the Biden administration makes a last-second sprint to boost awareness of the Jan. 15 deadline. Of the record-breaking more than 14.2 million, there were 10 million people who signed up for coverage on the federally run HealthCare.gov and the remaining via state-based exchanges, administration officials shared during a call with reporters on Thursday. The administration has made a major boost to outreach this year to make consumers aware of enhanced subsidies and lower cost-sharing passed under the American Rescue Plan Act. Fierce Healthcare, January 13, 2022 CMS proposes Part D price concessions be applied at point-of-sale, new requirements for MA plans The Biden administration wants Medicare Part D plans to apply any price concessions they get from drugmakers to the point-of-sale and require Medicare Advantage plans to be more transparent in how they spend money on supplemental benefits. The Centers for Medicare & Medicaid Services (CMS) released a proposed rule late Thursday that outlined major regulatory changes for MA and Part D starting in 2023. The rule covers a swath of major areas that include new changes for dual-eligible special needs beneficiaries and updates to calculations of star ratings, which can affect quality bonuses delivered to plans. Fierce Healthcare, January 6, 2022 South Dakota Voters to Decide Medicaid Expansion South Dakota voters will decide in November whether the state should become the 39th to expand Medicaid under the Affordable Care Act, a move that would provide coverage to 42,000 low-income residents. State officials on Monday officially placed the issue on the ballot after validating thousands of petition signatures. For nearly a decade, the Republican legislature has opted against expansion, citing concerns about the federal debt and worries that Congress would eventually cut federal funding for the program. Kaiser Health News, January 6, 2022 Low Value Care in Pediatric, Inpatient Care Cost $17M in 2019 Low-value care in pediatric inpatient care has a high price tag, according to a recent study published in JAMA Network Open on pediatric hospital spending for low-value services. “As strategies to measure pediatric low-value care evolve, hospital-based care warrants particular attention. This care is increasingly costly, and literature on overuse of nonrecommended hospital-based pediatric services is robust, suggesting improvement opportunities,” the researchers wrote. HealthPayerIntelligence, January 5, 2022 Medicaid Expansion May Be Associated with Lower Mortality Rates States that implemented Medicaid expansion saw reductions in all-cause mortality rates compared to nonexpansion states, a study from the Keck School of Medicine at the University of Southern California (USC) found. The Affordable Care Act authorized states to expand their Medicaid programs in 2014, but as of 2021, 12 states have yet to expand. HealthPayerIntelligence, December 20, 2021 |
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