Detailed guidance on the CMS “built-in” stop loss for the Global and Professional Direct Contracting (GPDC) model was released on January 7, 2022. DCEs that want to meaningfully compare this coverage to the market will need a highly specialized risk...
Disputes over value-based care arrangements have become common, as payors and providers often lack a clear understanding of agreement terms. Risk, data-sharing, and calculation methodologies are typically at the center of disputes. Read about a recent dispute in NJ...
The report provides valuable insights into its value-based care (VBC) programs. It also highlights comparative outcome, quality and patient satisfaction data between its VBC and fee for service beneficiaries – both in population health and bundled payment...
Legal disputes over the results of commercial value-based care (VBC) contracts are mounting. Groups should immediately rethink their strategy to accept the “built in” stop loss from payors. Here’s why: 1..Negotiation Most groups in VBC programs with commercial...
In an important letter for value-based care (VBC) participants, Centers for Medicare & Medicaid Services (CMS) is asked to confirm that reimbursed expenditures are properly accounted for. Click here to read the letter. Visit our Advisory Board page for more...
In a major victory for the independent practice of medicine and the value-based care movement, a lawsuit brought by The American Hospital Association (AHA) against The US Dept. of HHS* was dismissed on summary judgment. The US District Court of DC upheld the mandate...
Value-Based Healthcare: Four Elements for Success As it exists under the current fee-for-service (FFS) paradigm, US Healthcare is unaffordable, untenable and unsustainable. It is crucial that the prevailing framework evolve with value-based care (VBC) models, which...
Brian S. Kern, Esq. In 2019, the US spent $3.8 Trillion on healthcare. At 18% of GDP, this figure is neither affordable nor sustainable. Efforts by the federal government to rein in healthcare spending have been met with fierce resistance from corporate interest...
If there was any question that US Healthcare’s transition from fee-for-service to value-based would continue under the Trump Administration, the US Department of Health and Human Services’ (HHS) report, “Reforming America’s Healthcare System Through Choice and...
