The Medicaid cuts are dire in the Big Beautiful Bill. Some of the forthcoming changes and cuts are still a couple of years away, but now is the time to prepare. We should remember how important Medicaid is and why, and continue to talk widely about its value and its challenges. We should also understand… Read More »
The transition to value-based care (VBC) is fundamentally transforming the healthcare landscape, and 2025 is poised to be an inflection point to see whether the promise of VBC can be realized. For healthcare professionals – and especially for ambulatory care practices – embracing the nuances of this dynamic environment is essential not only for delivering… Read More »
We don’t always think of health insurers as communicators. However, when insurers set reimbursement rates, they provide information that directly influences service delivery. When payors reimburse for certain services, they are informing providers these services are valued and providing these services is encouraged. When payors do not reimburse for services, or reimburse at lower rates,… Read More »
The need for a comprehensive payment approach that supports the entire maternity care experience from prenatal, labor, and delivery, to postnatal care, is critical for both maternal and child health outcomes. Aligning payment to reward better birth outcomes is becoming more widespread. A handful of states are experimenting with bundled payments to advance value-based payment… Read More »
VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… Read More »
Value-based care is all the rage in health care system transformation. Promising in concept, value-based care initiatives aim to reward value over volume, shifting our understanding and practice of delivery and payment reform. These efforts received governmental support in 2015 via the Medicare Access and CHIP Reauthorization Act (MACRA), which launched a myriad of quality… Read More »