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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 […]

It’s time to prepare for the inevitable: The Centers for Medicare and Medicaid Services is moving more strongly to downside risk, increasingly the likelihood of new, mandatory alternative payment programs. Fortunately, health care organizations can leverage current Medicare programs to accelerate their move to full risk and population health. How do you evaluate which programs […]

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 […]

With CMS, CMMI and State Medicaid programs signaling their desire to include SDoH data into the financial model for managed care and programs like ACO REACH, and NCQA looks to include SDoH in HEDIS measures, providers and payers are grappling with best ways to address social determinants of health. It is important to note that […]

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 […]

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 […]

It’s the time of year when Joe Namath and other personalities are taking to the airwaves to tell seniors about the benefits of Medicare Advantage (MA) plans. For seniors, choosing between traditional Medicare and MA plans during the annual enrollment period can have a significant financial impact. The same holds true for health care providers […]

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 […]

In the recent Modern Healthcare article “Addressing healthcare worker burnout as another COVID-19 fall nears,” COPE Health Solutions Principal and Workforce Development Expert Elizabeth DuBois offers immediate actions providers can take to address some of the healthcare workforce’s acute pain while putting in place procedures and programs that take a strategic, longer-term approach to managing burnout. Two […]

Only 62% of projects complete within budget and 56% finish on time, according to the Project Management Institute’s 2021 Pulse of the Profession. Worse, 25% of all projects fail completely. Value-based health care projects are highly complex, particularly due to the significant cultural shift required. Whether you are a health system, health plan, IPA or […]