New Survey Demonstrates Health Care’s Continued Commitment to Value-Based Care Models
December 13, 2023
How Can APM Participants Better Engage Community-Based Organizations?
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Article Summary
Oct. 30, 2023
As they gain experience with alternative payment models, how can healthcare executives do a better job of partnering with community-based organizations (CBOs) to address patients’ health-related social needs and decide what is meaningful to measure? A panel of innovators at the Health Care Payer Learning & Action Network (LAN) Summit in Washington, D.C., described their experiences.
New Survey Demonstrates Health Care’s Continued Commitment to Value-Based Care Models
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Article Summary
Oct. 30, 2023
AHIP issued this statement as the Health Care Payment Learning & Action Network (HCP-LAN) released the results of its calendar year 2022 Alternative Payment Model (APM) measurement survey conducted in partnership with AHIP and the Blue Cross Blue Shield Association (BCBSA). The LAN survey is designed to understand how widely value-based care models are being adopted as health insurance providers, clinicians, hospitals, and health care systems work together to move from paying for volume to value. The results include the percent of provider payments and lives covered through APMs by line of business (LOBs)—Commercial, Medicaid, Medicare Advantage (MA), and original Medicare.
Value-Based Care Bending Cost Curve and Gaining Momentum
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Article Summary
November 1, 2023
The Health Care Payment Learning Action Network (HCP-LAN) convened its annual daylong summit on October 30, joined by providers, payers and government staff to discuss how the health care system is progressing toward adoption of accountable care. Some reflected on the recent report that annual Medicare spending per beneficiary is $10,000 less than projected ($3.9 trillion total below projections), as noted in a recent New York Times article. Over the past decade, average spend per Medicare beneficiary has remained relatively even and some at the Summit claimed it is evidence that moves away from Medicare FFS toward value-based care are achieving the desired goals.
Value-based care growth stagnant in 2022
Read the original article from Becker’s Payer Issues
Article Summary
Nov. 2, 2023
Value-based care models did not grow from 2021 to 2022, though more dollars moved to two-sided risk-based models, according to the Healthcare Payment Learning and Action Network’s annual report published Oct. 30.
In 2022, 40.6% of healthcare dollars were in fee-for-service arrangements with no link to quality or value, similar to 40.5% in 2021. In 2022, 24.5% of dollars were spent in two-sided risk arrangements, up from 19.6% in 2021. The remaining 35% of dollars were spent in fee-for-service arrangements with links to quality or models with upside-risk only.
Overall, 36.1% of covered lives in the report were in value-based payment arrangements.
Value-Based Reimbursement Grows as Providers Take on More Risk
Read the original article from RevCycle Intelligence
Article Summary
Oct. 30, 2023
Over half of healthcare payments last year were made through value-based reimbursement models, with most of those payments tied to some degree of financial risk, according to the latest data from the Health Care Payment & Learning Action Network (LAN).
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Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
