U.S. House Members Press CMMI’s Fowler on Lack of Cost Savings

Healthcare Innovation | June 14, 2024

At a June 13 congressional hearing, Elizabeth Fowler, Ph.D., J.D., director of the Center for Medicare and Medicaid Innovation (CMMI), was pressed to explain why so few of CMMI’s alternative payment models have produced cost savings. In a meeting of the Health Subcommittee of the the U.S. House Energy and Commerce Committee, Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, began by outlining her concerns. CMMI was created to help improve how Medicare and Medicaid pay for healthcare and to be an engine in our drive towards value-based care, Rogers said. “CMMI was given a 10-year, $10 billion budget and extremely wide-ranging authorities with limited built-in congressional oversight. The only directives Congress gave CMMI were to achieve two goals: lowering the cost of delivering care and improved patient outcomes.”

Five Things to Know About Medicare Site-Neutral Payment Reforms

KFF | June 1, 2024

Amid rising concerns about health care spending and voters’ worries about health care affordability, there is growing, bipartisan interest in proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site neutral” payments. The goal of this approach would be for Medicare to pay the same rate for the same service, whether it is provided in a hospital outpatient department (HOPD), ambulatory surgical center (ASC), or freestanding physician office, subject to patient safety and quality safeguards. Private payers could also achieve savings if they adopt similar payment policies. Policymakers have been focusing recently on site-neutral payment reform in response to concerns about health care costs and the rapid pace of consolidation, given that the differences in payment across settings for the same service create a financial incentive for hospitals to acquire physician practices.

How the Call Center Can Be a Driver for Value-Based Care

Healthcare IT Answers | June , 2024

Healthcare call centers are embracing artificial intelligence (AI) and automation as tools for both improving the patient/plan member experience and streamlining processes to increase efficiency and reduce costs. Provider and payer organizations can greatly benefit from delivering a superior customer experience; if they can do so while cutting costs, that’s even better. But AI and automation also allow providers and payers to evolve the call center beyond the traditional “ask/answer” cost center to a value center by identifying and leveraging opportunities to increase revenue. Contact centers play critical roles in patient acquisition and retention, and they will always need to deliver a human touch in some conversations.

5 Key Takeaways from AHIP 2024

AaNeel | June 19, 2024

The annual AHIP (America’s Health Insurance Plans) conference is always a cornerstone event in the healthcare industry, bringing together leaders, innovators, and policy makers. This year’s AHIP 2024 was no exception, offering a wealth of knowledge and insights. Here are the top five takeaways that will shape the future of healthcare. A major theme at AHIP 2024 was the ongoing shift from fee-for-service to value-based care models. Speakers and panels underscored the importance of focusing on patient outcomes and reducing unnecessary costs. This approach not only improves patient satisfaction but also drives better financial results for healthcare providers. Attendees were particularly interested in strategies for implementing value-based care models in a variety of healthcare settings, highlighting successful case studies and sharing best practices.