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VBP pilot programs underway in New York State

In New York State (NYS), as the final results for measurement Year 2 are solidifying, Value-based Payment (VBP) pilot programs are starting. The VBP pilots do not have an easy task in front of them...

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Moving from “the data is wrong” to “all data is flawed but still useful”

Value-based purchasing and population health management are supposed to change aspects of the relationship between insurers (health plans) and providers (accountable care organizations, health systems,...

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Risky business: Achieving value-based purchasing goals in New York State

I’ve spent much of the last few months traversing the State of New York speaking to our Medicaid MCOs about their strategies to reach the state’s value-based purchasing (VBP) goals. It’s been well...

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How can we match the right resources and interventions to patient needs?...

With the unrelenting pressure to reduce unnecessary costs in healthcare delivery and despite (or maybe because of) the lack of clear direction from the federal government, Medicaid plans across the...

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Four ways HCCs impact health systems

Hierarchical Condition Categories (HCCs) have been the underlying risk adjustment for many Medicare programs for several years. But they didn’t attract wide interest until CMS began shifting more...

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Solving the mismatch between poor quality scores and outstanding care

Recently, I reviewed the Medicare Hospital Value-Based Purchasing (VBP) scores for three hospitals recognized nationally for outstanding care and patient safety. They didn’t look good. The ratings for...

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Does Medicare’s value-based purchasing model really create value in...

Value-based reimbursement is the soup du jour in the medical industry these days. How value is defined, however, can vary depending on one’s perspective. Most experts in the field agree that the metric...

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What are America’s Health Insurance Plans thinking about in these tumultuous...

These times of uncertainty and stress press us to rethink what we are doing and where we are headed in terms of health care. I had a chance to speak with Matt Eyles, President & CEO of America’s...

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Four key problems with current value-based program design: How might we...

If we want better health care outcomes in the U.S., we need to change the way we finance health care. Policies flowing from Medicare are a strong signal to the health care system given its size. The...

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Transitional care interventions: Evidence supports more intense interventions

Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is...

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