Data and technology, once simply functional assets to facilitate health care, are now a leading force for health care advancement, improvement of health care outcomes, and control of costs. Yet the panoply of technologies has not optimized information for one key actor: the patient. The Center for Medicare and Medicaid Services (CMS) is attempting to […]
Let’s Put an End to What Blocks Providers and Patients from Controlling Health Care Costs
We often blame providers for not controlling health care costs. We also put the onus on patients who overuse care inappropriately and make bad choices. But the fact is that control of health care costs is extremely complicated, and we have effectively blocked both providers and patients from controlling health care costs. Since the birth […]
Multi-Payer VBC Strategy Is Essential for Cost Control, but Providers Must Get a Fair Deal
To meet its goals of controlling costs and improving patient care, Value-Based Care requires a near-universal, multi-payer strategy.
5 Things I Learned from Speaking at the Spring Managed Care Forum
One of my favorite professional activities is to speak to a broad health care audience and get feedback on their response to reform initiatives. Last week I spoke at the Spring Managed Care Forum in Orlando, Florida. The Fall and Spring forums are a favorite venue for me, and I never fail to get new […]
Why Hospital Giants Are the Next Battleground in the War on Costs
Hospitals are just emerging from several years of post-pandemic planning and correction, when sustainability was the overriding issue. Now consolidation has driven up costs—largely by improving health systems’ negotiating power. Indeed, most studies show that after mergers, whether vertical, horizontal, regional, or national, the costs are higher. New federal budget proposals on the table are […]
3 Essentials to Cut Health Care Costs Without Cutting Patient Care
There is an understandable fear and a little outrage right now about health care budget cuts. Some proposed cuts will raise the amount of unfunded care for hospitals and physicians if Medicaid coverage is reduced, and impact patients in nursing homes. Other proposals will eliminate offsets for medical debt or physician education through residency programs. […]
Curate Your Data to Tackle Cost of Care: Master These Basics
The staggering reality that health care could soon account for one fifth of all domestic spending has put a bull’s eye on health care cost control. Is your ACO, health system, or physician organization ready to manage the coming congressional budget cuts? The only effective way to tackle Total Costs of Patient Care (TCoC) without […]
Value-Based Care 2025: Providers Must Win the War on Costs
Health systems and ACOs: Prepare yourself for the return to cost containment as the central objective of Value-Based Care in 2025. While cost measures have always been part of CMS Value-Based Care quality programs, their impact was small relative to the total MIPS score for physician groups. Likewise, ACO savings look big in dollars but […]
To Unlock ACO Access to Real Savings, Start with Trusted Data
Value-Based Care payment models are based on a clear CMS goal: lower Total Cost of Care and its counterpart, Total Per Capita Cost. But neither TCoC nor TPCC gives you the information you need to target your cost efforts. How to start? Begin by evaluating what initiatives you need to do in the five key […]
CMS Presses for Accountable Care, Better Quality Measurement for Physicians and ACOs in New Proposed Rule
July brings us baseball, fireworks, and CMS’s Proposed Rules. In 2,248 pages of proposals, CMS has outlined its plans for MIPS, ACOs, and other Advanced Alternate Payment Models, and how they will transition from fee-for-service into a value-based care arrangement through the Quality Payment Program (QPP). We already know from the 2024 Final Rule that […]