Medicare has become more of a private marketplace — and it’s costly
Medicare Advantage is fundamentally altering Medicare's structure. More
Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk
This cohort study evaluates the Merit-Based Incentive Payment System scoring of surgeons caring for patients at high social risk to assess whether this implementation is associated with patient access to surgical care. More
Private Equity and Health Care Delivery: Value-Based Payment as a Guardrail?
This Viewpoint considers how payment models may dictate the nature of private equity investment in health care delivery and how these investments may affect health care access, quality, equity, and affordability. More
Transforming Health Care to Address Value and Equity
This Viewpoint explains the national Vital Signs initiative—developed by the National Academy of Medicine to track improvements in health, health care costs, engagement of the public in its health, and health care and quality. More
UnitedHealthcare delays ER claims policy following backlash
UnitedHealthcare's new policy, which could reject as many as 1 in 10 claims, was labeled as "dangerous" by the American Hospital Association. More
Can a Subscription Model Fix Primary Care in the US?
Medical subscriptions, a $199 million CEO payday and the race to fix primary care in the U.S. One Medical is betting big that a subscription model can fix primary care. More
Viewpoint: A Path Forward for Alternative Payment
This Viewpoint explores existing payment models and waste elimination incentives and proposes a new approach to addressing waste in health care. More
Employers Cut Health Costs With Incentives for Patients, Doctors
Employers can cut their health-care expenses by paying top medical providers a flat rate for a bundle of related services while offering incentives to the patients who use them, a study suggests. More
Hospital Revenue Under Maryland’s Total Cost of Care Model During the COVID-19 Pandemic, March-July 2020
This study compares revenue of Maryland hospitals in March-July 2020 vs historical trends and assesses whether rate increases for inpatient and outpatient services that were permitted to offset pandemic-related decines in revenues were associated with changes to state hospital revenue. More
Challenges of a Supplemental Private Option Under National Health Insurance—Observations From Australia
This Viewpoint describes the role of private hospital insurance in Australia, a country with universal government-sponsored insurance. More
Going Beyond One Size Fits All in Surgical Bundled Payments
This Viewpoint highlights 2 ways, based on insights from industries outside health care, to increase participation in and benefits of surgical bundles. More
Pharmacists in Ohio managing care as providers—and getting paid for it too
An insurer-led experiment adds community pharmacists to care teams in the hope of controlling chronic conditions and reducing hospital readmissions. More
Capitated payment models come with lots of hidden and not-so-hidden hurdles
The pandemic has prompted many physician groups to consider taking on risk, including capitated payments. Experts say there are regulatory, logistical hurdles to consider. More
Value-based care now at risk
Both CMS and healthcare providers are using COVID-19 as an excuse to cut back on their experiments in value-based care, a severe blow to those hoping the pandemic would catalyze badly needed change. More
How Foundational Moments In Medicaid’s History Reinforced Rather Than Eliminated Racial Health Disparities
The past months have laid bare the inextricable connection between two pandemics in the United States: COVID-19, which is disproportionately affecting Black Americans, and systemic racism, which has set the foundation for the stark health disparities we see today. More
The Hospital Industry Is In A Financial Mess: We Have A Unique Opportunity To Fix It
Since the declaration of COVID-19 as a pandemic in early March 2020, there has been a deluge of articles describing its horrible effects on hospital finances. More
Out-of-work patients, families eye direct primary care as their best healthcare options during COVID
Faced with skyrocketing health insurance premiums, Texans are turning to a growing niche of primary care to cover their medical needs during the pandemic. More
Primary Care Doctors Look at Payment Overhaul After Pandemic Disruption
Like other businesses around the country, many doctors were forced to close their offices — or at least see only emergency cases — when the pandemic struck. That led to sharp revenue losses, layoffs and pay cuts. More
Family doctor, employer groups join forces to replace fee-for-service
The American Academy of Family Physicians and National Alliance of Healthcare Purchaser Coalitions look to scale a care model that aims to shift away from fee-for-service reimbursement. More
COVID-19: A Boost for Capitated Payment Models
They can provide a steady income even in 'down' times More