CMS has unveiled a new payment model aiming to support health equity in the states by shifting health care to community-based settings. The agency is already addressing health equity in other models, such as Enhancing Oncology Model and ACO REACH. The States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) aims to better address chronic disease, behavioral health, and other medical conditions by equipping states to promote health equity, increase access to primary care, encourage more sustainable health care spending, and lower costs for patients.

Interoperability and related compliance mandates are not new, though the landscape is ever changing. Without these two key components, progress is at stake. No one wants to return to the Wild West of health data and record keeping. Fortunately, the health care industry has been hard at work to put a national standard in place much like other industries, including finance, retail, and travel, to name a few. Despite the hard work of organizations like the Workgroup for Electronic Data Interchange, challenges persist with disjointed and disconnected health care data systems. While the widespread adoption of electronic health records was a significant improvement (albeit complicated, and for many ongoing), data silos and the lack of true interoperability remain.

Risk for Reward: Two-Sided Risk is Crucial to Win in Value

Lumeris| September 12, 2023

Healthcare is hard. While the American healthcare industry is filled with complexity as it seeks to interweave between multiple care delivery settings, care providers, and payment mechanisms – it points out the obvious that many new entrants into the industry experience: Making changes in healthcare and obtaining winning results is hard. With Medicare as typically the largest payer for providers, the Centers for Medicare and Medicaid Services (CMS) has the best opportunity to succeed in transforming the industry to a value-based-driven system. As Medicare moves markets in risk-bearing arrangements, commercial carriers will begin to adopt provider accountable care programs that will include risk/reward opportunities. That said, CMS carries the burden of catalyzing change, and that comes with hard decisions and actions to reconstruct incentives.

The shift toward value-based care (VBC) is increasingly taking hold in health care as practices continue to face challenges with stagnant fee-for-service reimbursement rates and medical cost inflation. To succeed in a VBC environment, practices must adopt patient engagement as a foundational capability. Better patient engagement not only helps keep patients healthy and from needing higher-cost care or hospitalization, but also builds loyalty, helps meet quality measures, and reduces risk. In this article, we explore why patient engagement is critical to VBC success and discuss steps to engage patients digitally for effective care management.

AaNeel knows that surviving in today's healthcare market is no easy task for value-based care organizations. That is why they created a system specifically designed for ACOs. Their custom HIPAA-compliant solution helps ACOs maximize their revenues and is customizable for each organization's specific needs. AaNeel excels in improving the quality of patient-centered care through cost containment methodologies in order to achieve shared savings with exceptional quality scores for ACOs and health systems.

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