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Prepare for another bumpy year. With the rise of the omicron variant and a sizable minority of Americans who remain unvaccinated, COVID-19’s grip on the U.S. health system, economy and society is not loosening any time soon. For health plans, the impact will be far, wide and deep, underscoring the need for recalibrating operations and […]

The light at the end of the tunnel has proved farther away than had been hoped at the start of 2021. Widespread availability of COVID-19 vaccines has led to a semblance of normalcy, with a lifting of many 2020 restrictions, such as indoor capacity limits, return to in-person schooling and the opening of most countries’ […]

By 2030, one in every five Americans will be 65 or older, according to the U.S. Census Bureau. That year, Medicare spending will hit $1.7 trillion, up from $835 billion in 2020, estimates the Congressional Budget Office. But don’t expect business as usual. While The Centers for Medicare & Medicaid Services (CMS) have experimented with […]

Health equity is at the top of the agenda for growing numbers of providers as well as the Biden Administration: 58% of health systems now say health equity is a top priority, up from 25% in 2019, according to the Institute for Healthcare Improvement. A key to erasing racial and ethnic healthcare disparities including access […]

When health leaders are scrambling to ensure adequate staffing every single day, bringing a more strategic focus to their healthcare workforce may not make it to the top of the to-do list. But a long-term holistic approach that begins quickly paying off is exactly what’s needed to move away from the constant staffing fire drills […]

If you’re thinking about starting a new health plan or expanding your offerings, you are not alone. Take Medicare Advantage. In response to the fast growth in the Medicare-eligible population and strong interest in Medicare Advantage, both new and established insurers have seized this opportunity. In the past five years, the number of MA plans […]

The national trend across all lines of business toward more risk arrangements means most health systems and physician groups are operating in pluralistic payment environments. They earn some of their revenue through traditional fee-for-service and other portions come from shared savings, bundled payments, capitation and other value-based payments. Figure 1: Payment System Spectrum: While […]

The Centers for Medicare & Medicaid Innovation has laid out a new framework for driving health system transformation over the next 10 years. While CMMI did not announce specific changes or new programs as of yet, the focus on value-based care, aligning financial incentives through value-based payments and health equity — and making more progress […]

Increasing number of providers and payers are grappling with best ways to address social determinants of health to improve outcomes and reduce cost of care. However, providers and payers are neglecting an important and readily available tool. That tool is Z codes, which include a subset of ICD-10-CM codes created to report social, economic, and […]

The shift to value-based payments and value-based care is the most complex and far-reaching transformation being undertaken by U.S. health care in our lifetimes. One proven way to increase the chance of success in any project, let alone one the size and scope of the wholesale move to population health management and risk contracting, is […]