红领巾瓜报 Insights: Your source for healthcare news, ideas and analysis.
红领巾瓜报 Insights 鈥� including our new podcast 鈥� puts the vast depth of 红领巾瓜报鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.
红领巾瓜报 and Wakely Share Expert Insights on VBC Landscape
In this webinar, experts from 红领巾瓜报 and Wakely reviewed the nation鈥檚 progress in the movement to value-based payment models and looked ahead to its next chapter, sharing 红领巾瓜报鈥檚 views on future expectations for CMMI鈥檚 model portfolio, how shifting market and policy dynamics may impact MA contracting, and the state of value-based enablers, health systems, other risk-bearing provider entities impacted by these forces. 红领巾瓜报’s VBC Advisory Services team supports organizations with integrated insights across strategy, analytics, and implementation to drive measurable results in value-based care.
Learning Objectives:
Review the current state of APM adoption and key trends聽
Explore the CMS Innovation Center’s recent activities and potential focus areas for future models聽
Understand policy and market headwinds facing Medicare Advantage plans with implications for VBC聽
Gain insights into participation trends among health systems, enablers, and states
Hospitals and health systems are under growing pressure to succeed in new value-based models that demand both operational transformation and strategic alignment. In this webinar, advisors from 红领巾瓜报, Wakely, an 红领巾瓜报 Company and Nixon Peabody broke down the latest regulatory and contractual developments, explored lessons learned from the Comprehensive Care for Joint Replacement (CJR) model, and discussed how organizations can prepare for upcoming opportunities.
Speakers shared practical insights on:
The regulatory, operational, and actuarial considerations hospitals must navigate
Key takeaways from bundled payment initiatives like CJR
How to leverage data and design strategies to build partnerships that position organizations for success in new Medicare models
This session was designed for hospital executives, provider organizations, payers, and policy leaders seeking to better understand how emerging value-based models will shape the future of care delivery and payment.
On May 13, 2025, the Centers for Medicare & Medicaid Services (CMS) published its new for the CMS Innovation Center. The strategy builds on the lessons of the first 15 years of the Innovation Center, while presenting a significant pivot in policy direction, which emphasizes evidence-based prevention, consumer engagement, and tech-enabled care, while prioritizing financial performance over broad participation.
The provides high-level direction on the Trump Administration鈥檚 vision for the next phase of value-based payment reform under the leadership of CMS Administrator Dr. Mehmet Oz and Innovation Center Director Abe Sutton. They intend to 鈥渄ouble down on our commitment to value-based care and take the learnings from the[se] previous investments to build a health system that empowers people to drive and achieve their health goals and Make America Healthy Again.鈥� Notably, the strategy also aligns with goals central to the Trump Administration鈥檚 .
This new direction affirms the administration鈥檚 commitment to continue advancing value-based care and opens additional opportunities for organizations seeking to enhance the delivery of services that drive positive outcomes. 红领巾瓜报 (红领巾瓜报), experts will be tracking the implementation of the Innovation Center鈥檚 new strategy, including expected forthcoming models, movement toward greater levels of downside risk, and changes to existing models to align with the administration鈥檚 priorities. In this article, our experts review the strategy and provide insights on key takeaways for stakeholders.
New Strategy Overview
CMS leaders view the Innovation Center agenda as a framework for accelerating healthy behaviors, leveraging the agency鈥檚 authority to test new approaches designed to incentivize and engage stakeholders. According to CMS officials, the Innovation Center 鈥渨ill work expeditiously toward the future of health鈥攂uilding a system in which people are empowered to achieve their health goals and providers are incentivized to compete to deliver high-quality, efficient care and improve the health outcomes of their patients.鈥�
The strategy has three interrelated, foundational pillars:
Promoting evidence-based prevention
Empowering people to achieve their health goals
Driving choice and competition.
Table 1 provides more detail on each pillar.
In addition to the new agenda, CMS released a seeking industry input on strategies that can better leverage data and technology to empower consumers. The focus of the RFI aligns with the Innovation Center鈥檚 strategic pillars to use tools, information, and processes that better connect people to their health data and allow them to make informed health decisions alongside their providers.
Table 1. CMMI鈥檚 Interrelated Strategic Pillars
Takeaways and Considerations
Critical to CMS鈥檚 approach is the belief that empowering individuals to make their health decisions鈥攖hrough incentives, better data access, and more flexible options鈥攃an lead to better health outcomes and lower overall costs. This shift reflects an evolution in healthcare policy that places greater emphasis on personal accountability and private sector collaboration鈥攁 key theme that is emerging across the administration鈥檚 policy initiatives.
Consumer Engagement. One of the most notable aspects of the new Innovation Center strategy is the promotion of consumer engagement; it places more focus on direct consumer engagement through education and incentives compared with earlier initiatives. This is one area in which the Innovation Center plans to collaborate with the private sector to develop consumer-facing tools (e.g., mobile apps, nudges toward healthy behaviors, etc.).
The focus on consumer engagement also presents opportunities for organizations to enhance their customer experience. By understanding the needs and preferences of their patients, organizations can tailor their services and care models to better meet those demands. This personalized approach not only improves patient satisfaction, but also drives continuity of care, ultimately contributing to long-term improvements in health.
Data and Technology. The new strategy also emphasizes the importance of data, indicating intentions to better equip organizations that participate in the model with data that can inform decisions and optimize their processes. CMS officials are examining policies and collaborations that will empower private sector organizations, including model participants, researchers, and technology vendors, to develop innovative data-driven solutions to drive efficiencies and improved health.
To that end, the May 16, 2025, Request for Information (RFI) from CMS and the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health (ASTP/ONC), (CMS-0042-NC), focuses on Medicare beneficiaries’ use of technology to improve health outcomes. The RFI, which 红领巾瓜报 experts analyze here [insert bookmark or link to the other In Focus article] underscores the administration鈥檚 intentions of taking 鈥渂old steps to modernize the nation鈥檚 digital health ecosystem.鈥�
Medicare Advantage. The Innovation Center鈥檚 new strategy indicates that stakeholders should expect more models that address Medicare Advantage (MA). The agency stated that 鈥渇eatures of a model could include testing changes to payment for MA plans, such as testing the impact of inferred risk scores, regional benchmarks, or changes to quality measures that better align with promoting health.鈥� Additionally, the strategy references a forthcoming specialty-focused longitudinal care model within MA and Medicaid, signaling intentions to drive multi-payer alignment.
Saving Federal Tax Dollars. Another major aspect of the strategy is 鈥減rotecting federal taxpayers.鈥� This goal reflects a continued emphasis on total cost of care accountability and indicates a more aggressive shift to downside risk. The Innovation Center says it will 鈥渞equire all models to have downside financial risk and require providers to assume some of the financial risk..鈥� Additional provisions of protecting tax dollars include reducing role of state governments in rate setting, simplifying model benchmark methodology, and ensuring 鈥減roper and nondiscriminatory provision of funds for health care services.鈥�
What to Watch
For healthcare organizations, the Innovation Center鈥檚 agenda signals a need to prioritize consumer-centric models. Hospitals, providers, and insurers should anticipate the following:
Increased focus on preventive care initiatives to align with new model designs
More robust data-sharing and technology requirements, meaning investments in patient-focused digital tools will become essential
New opportunities in MA, given potential payment model innovations affecting plan structures and risk-adjusted reimbursement
Healthcare stakeholders should monitor possible developments related to the strategy.
While details on specific strategies have yet to emerge, the Innovation Center it plans to provide more information on new models, as well as changes to existing models, in the coming months.
The Innovation Center has not provided a goal akin to the previous administration鈥檚 effort to have 100 percent of Medicare beneficiaries in accountable care relationships by 2030. It is still unknown whether these goals are forthcoming or if this will remain vague.
Stakeholders are still awaiting clarity on changes to existing models, including key models set to conclude at the end of 2026 (i.e., ACO REACH and Kidney Care Choices).
Strategy language indicates that the agency may develop payment innovation in prescription drugs, medical devices, and technology.
Connect With Us
The 红领巾瓜报 Annual Conference, , October 14-16, 2025, in New Orleans, LA, will feature discussions on how the new strategy is reshaping the healthcare system and care delivery for patients, particularly the opportunities to revisit provider contracts with MA plans and to integrate technology to advance the prevention of chronic conditions and achieve population health goals.
For more information about the opportunities and considerations the Innovation Center agenda presents for your organization, contact 红领巾瓜报鈥檚 featured experts below.
Digital Quality Measurement: A Key Driver to Value
The healthcare industry is on the cusp of a seismic shift in how quality data are collected, analyzed and reported. Beginning in January 2027, new federal interoperability and prior authorization rules will require widespread data exchange, paving the way for full digital quality measurement (dQM) by 2030. This move toward dQM presents enormous opportunity to enhance quality outcomes, strengthen value-based arrangements, and streamline operations. However, it also requires substantial strategic, operational, and technological changes that most organizations simply cannot manage alone.
Regulatory Mandates
Organizations that delay preparing for the 2027 rule risk costly setbacks and non-compliance.
Opportunity for Transformation
dQM drives efficiency and quality improvement, supporting population health initiatives, care coordination, and value-based contracting.
Complexity and Risk
dQM implementation spans multiple departments鈥擨T, quality improvement, analytics, legal, and more鈥攃reating a host of challenges requiring specialized expertise.
Competitive Advantage
Early adopters will have a first mover advantage. This advantage could result in revenue associated with auto-assignment, STARS bonus, value-based purchasing, reduced sanctions and fine, etc.
Why Partner with 红领巾瓜报?
红领巾瓜报鈥檚 dQM consulting team understands the operational, clinical, and technical dimensions of transitioning to digital quality measurement. Leveraging deep expertise across health plans, provider organizations, and state and federal agencies, we help you plan, implement, and evaluate your dQM strategies at every stage.
1. Speed to Solution
Front-Seat Knowledge: 红领巾瓜报, together with Leavitt Partners, an 红领巾瓜报 Company, is actively influencing and shaping national conversations on interoperability and digital measures. Our front-line insights mean you gain rapid access to the latest best practices, regulatory updates, and strategic guidance.
Streamlined Roadmap & Implementation: We help you develop a clear, achievable plan of action鈥攕aving you from the pitfalls of trial-and-error by fast-tracking your implementation and monitoring the results.
2. Cross-Department Coordination
Complexity of Transformation: dQM requires alignment across IT, quality, clinical operations, and finance鈥攐ften a monumental undertaking for organizations already at capacity. Robust change management & strategic planning and communications is crucial for success.
Meet Mandated Timelines: Waiting to act can result in financial risk, stressed operations, and missed opportunities to optimize reimbursement.
Manage Risk: Because digital quality measurement is in an emerging phase, organizations face higher levels of uncertainty. 红领巾瓜报 mitigates risk by leveraging our extensive experience and industry partnerships.
3. Proven Expertise and Ongoing Support
Full Project Lifecycle: From early planning and strategy development through implementation and evaluation, we stand by you every step of the way.
Value Beyond Compliance: Our team identifies how dQM can drive broader business goals鈥攊mproving population health, care coordination, and value-based contracting performance..
Ready to Transform Your Quality Measurement?
红领巾瓜报鈥檚 expert consultants provide the advanced technical, business, and operational skills you need to succeed in today鈥檚 rapidly evolving regulatory landscape. Don鈥檛 let the complexity of dQM derail your strategic plans or burden your teams. With 红领巾瓜报 as your partner, you can confidently navigate and optimize your transition to digital quality measurement.
Take the first step toward harnessing the power of digital quality measurement. Partner with 红领巾瓜报 to position your organization for success today鈥攁nd well into the future.
Contact our 红领巾瓜报 dQM experts to discuss your organization鈥檚 goals and challenges:
Jennifer Bridgeforth, associate principal at 红领巾瓜报, dives into the complexities of fraud, waste, and abuse in healthcare, examining the blurred lines between inefficient processes and intentional misconduct. The conversation explores how value-based care, provider education, and technology could pave the way for more efficient and patient-centered healthcare. Listen to discover insights on navigating these challenges in a shifting healthcare landscape.
The Centers for Medicare & Medicaid Services (CMS) announced on December 16, 2024, that it will be terminating the (VBID) model at the end of 2025 because of the model鈥檚 鈥渟ubstantial and unmitigable costs to the Medicare Trust Funds.鈥� This In Focus article delves into the factors driving CMS鈥檚 decision and considerations for policymakers, Medicare Advantage Organizations and other interested stakeholders.
VBID Outcomes
VBID, run by the CMS Innovation Center, is not a permanent part of the Medicare Advantage (MA) program. Innovation Center models are required to be modified or terminated if they are a cost to the program.
CMS found that costs for the VBID model totaled $2.3 billion in calendar year (CY) 2021 and $2.2 billion in CY 2022, an unprecedent amount for an Innovation Center model. CMS concluded that these substantial expenses鈥攄riven by increased risk score growth and Part D expenditures鈥攚ere unmitigable through policy modifications. Therefore, consistent with statutory requirements, CMS took action to terminate the model by the end of 2025. Earlier this year, CMS announced it would discontinue the part of VBID that allowed MA plans to offer hospice services.
Next year, the VBID model will have 62 participating MA plans and is projected to offer 7 million Medicare beneficiaries additional benefits and/or rewards, including those designed to address social determinants of health and reduce cost-sharing for prescription drugs used to treat and manage chronic conditions. As part of the announcement, CMS pledged to support a stable transition for all enrollees in MA plans participating in the MA-VBID model and emphasized that key benefits available under the model will continue to be widely available, including supplemental benefits that address the whole-person healthcare needs of beneficiaries. In addition, CMS noted beneficiary cost-sharing for prescription drugs will be reduced as the result of the expansion of the low-income subsidy program under the Inflation Reduction Act and the CMS Innovation Center鈥檚 Medicare $2 Drug List Model, which is slated to begin in 2027.
As part of the announcement, CMS released an executive summary of a forthcoming evaluation report, with the full report expected to be released in early 2025.
Key Considerations
Since the MA-VBID model鈥檚 launch in 2017, the program has experienced significant growth through a series of legislative and model changes, including requirements in the Bipartisan Budget Act of 2018 that expanded eligibility to MA plans in all 50 states and allowing all types of MA special needs plans to participate in MA-VBID. Previous CMS found that the MA-VBID model led to improvements in the quality of care for beneficiaries and promoted greater adherence to prescription drugs used to treat and manage chronic conditions. Though CMS has concluded that excess costs require the termination of MA-VBID by the end of 2025, the incoming Trump Administration can be expected to closely examine this decision and look at the entire Innovation Center portfolio.
Connect with Us
红领巾瓜报, Inc. (红领巾瓜报), Medicare experts will continue to assess and analyze the response to CMS鈥檚 announcement, including the incoming administration鈥檚 views on the decision and potential alternatives. 红领巾瓜报鈥檚 experts have the depth of knowledge, experience, and subject matter expertise to assist MA organizations and interested stakeholders in analyzing and adapting to the marketplace as the MA-VBID program ends.
For further analysis of the MA-VBID decision and its impact on the market, contact our experts below.
红领巾瓜报 is hosting its 2024 Fall Conference October 7鈭�9 in Chicago, IL. promises to enhance your ability to navigate and shape healthcare programs and systems, focusing on improving health and well-being.
In a landscape dominated by endless video meetings, the offers a refreshing change. Join us for an enriching experience featuring:
Engagement with healthcare experts and thought leaders who are actively collaborating with stakeholders
Participation in face-to-face discussions to exchange ideas and receive valuable feedback
Opportunities to connect with peers who are committed to strengthening public programs and enhancing health outcomes
Keynote Address and Sessions
, from the Advanced Research Projects Agency for Health (ARPA-H), will deliver the Keynote Address. He and other speakers will inspire attendees to explore innovative healthcare programs and their potential impacts on healthcare delivery, reimbursement, and health outcomes.
The conference will feature a diverse array of speakers and participants, including C-suite executives from national, regional, and local health plans. Federal and state leaders joining panels will include:
State Medicaid directors from New York, Iowa, New Mexico and Alabama
State insurance commissioners
Behavioral health agency officials
State housing agencies
Leaders from the US Interagency Council on Homelessness
The conference will include a revamped pre-conference workshop on October 7, featuring hands-on exercises and interactive sessions led by 红领巾瓜报 leaders. Sessions will include a value-based care contracting exercise, a value-based purchasing assessment discussion for providers, tips and tricks on navigating Medicaid section 1115 demonstrations, AI applications in healthcare, and more.
View the , including speakers confirmed to date.
Registration
Early bird registration聽is open until July 31. Don鈥檛 miss this opportunity to gain actionable knowledge, forge valuable connections, and discover fresh insights and best practices.聽Register now聽to secure your spot at the forefront of healthcare innovation.聽
Innovation is the source of progress, driving advancements across industries and shaping the way we live, work, and interact. However, the landscape of innovation is not static鈥攊t ebbs and flows, influenced by various factors including political leadership. This year鈥檚 presidential election may bring forth significant shifts in priorities, policies, and funding that directly impact innovation efforts like Center for Medicare & Medicaid Innovation (CMMI), state waivers and the Advanced Research Projects Agency for Health (ARPA-H).
CMMI serves as a catalyst for testing innovative payment and service delivery models within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). With a new administration comes the potential for shifts in CMMI’s focus and funding priorities. For instance, a president (or his/her appointees) can direct CMMI to design payment models, reimbursement structures that can lead to higher quality outcomes and more cost-effective healthcare delivery. The policy priorities and values that undergird a president鈥檚 healthcare agenda can shape the kinds of innovation that CMMI drives. Current CMMI initiatives have prioritized value-based care approaches linking payment to outcomes, improving equity of care across race, gender, and geography, and patient-centered care models designed to support particularly high cost, complex conditions; the priorities of the previous administration included focus on substance abuse disorders, kidney disease, and diabetes.
CMS also grants waivers to states, such as Section 1115 waivers for Medicaid or 1332 waivers for insurance marketplaces, that offer flexibility to experiment with innovative healthcare solutions. The values and policy approaches of a new president will influence the degree of regulatory flexibility and the types of experimentation that will be approved. For example, several states have recently received approval on Medicaid waivers that encourage community-based approaches to whole person care, wrapping together healthcare coverage, benefits, delivery, with new support services that address upstream barriers to health.
ARPA-H, a new unit within the National Institutes of Health focuses on investments in 鈥渂reak-through technologies and broadly applicable platforms, capabilities, resources, and solutions that have the potential to transform important areas of medicine and health for the benefit of all patients,鈥� holds immense potential for driving breakthroughs in healthcare by funding innovation that 鈥渃annot readily be accomplished through traditional research or commercial activity.鈥� The types of projects funded by ARPA-H could be directly impacted by the policy and budget priorities of whomever is president in 2025 and their interest in promoting collaboration between government, academia, and industry to address complex health challenges. A prime example of a potentially impacted area is the emphasis on cancer research by the Biden Administration. This focus may shift drastically with a change in leadership.
For healthcare innovators looking to stay informed and adaptable amidst these potential policy changes, 红领巾瓜报 has two opportunities of interest: The 红领巾瓜报 Fall conference, and a DC Direct subscription. 聽On October 7-9, healthcare leaders and 红领巾瓜报 experts will gather for the , focused on innovation in public programs. Our keynote speaker Darshak Sanghavi, MD is, a foundational leader at ARPA-H tasked with developing health programs that challenge how we think about healthcare innovation inside and outside government. Conference registration is now open – register today.
Leavitt Partners (LP), an 红领巾瓜报 Company, guides clients who need to more closely track federal policy and regulatory activity and know when and how to influence the process. , an exclusive offering from LP, provides timely information and insights to elevate your knowledge from simply scratching the surface of understanding to becoming part of the fabric of change.
On March 6, 红领巾瓜报 convened a spring workshop of 100 healthcare stakeholders interested in making value-based care delivery and payment work better. This event was designed for those engaging in value-based care and payment transformation, but who are looking to learn from peers to overcome challenges; participants included insurers, health systems, data and tech innovators, service providers, and trade associations.
The event鈥檚 name implored people to 鈥淕et Real鈥� about the challenges we all face, while reminding ourselves of the imperative of making this transition to ensure the sustainability of our uniquely American healthcare system. In between plenary panels, participants were engaged in cohort discussions exploring the opportunities for progress in areas critical to making value-based care work. While a summary cannot recreate the real-time discussions and simulations from the event, our discussions delivered insights on several critical themes that we believe are important to track.
EMPLOYERS ARE LEANING IN:For all employers pay, they are getting less value over the past decade; the changes made to ERISAthat hold the C-suite accountable for paying fair prices for healthcare benefits is a seismic shift in making healthcare purchasing a more strategic priority for employers.
Elizabeth Mitchell of the Purchaser Business Group on Health illustrated the shift in employers鈥� awareness 鈥� due to data transparency rules 鈥� that they aren鈥檛 getting the quality they thought they were getting for all that they pay. Transparency, plus a recent change to the Employee Retirement Income Security Act of 1974 (ERISA), is bringing employers back to the table with very specific requests for better outcomes, which they are increasingly pursuing through direct contracting and specific quality frameworks for primary care, maternal care, and behavioral health. Participants continued to reflect on this dynamic in all subsequent discussions, underscoring that this could be a really big deal.
Cheryl Larson of the Midwestern Business Group on Health talked about the cost pressure on her members leading them to partner in new and different ways, expressing optimism about all payer solutions and other innovative approaches to leverage the cost data that are now available. In her closing plenary session, she said 鈥渢his issue of accountability on employers鈥 am excited and optimistic that there are things we can do to get there faster now.鈥�
Data & Technology HAVE TO IMPACT DECISION MAKING: Patients are using the system the way it is designed today, so we can鈥檛 just blame them for poor outcomes鈥e have to actually stop doing things that don鈥檛 work and start measuring things the right way.
Dr. Katie Kaney opened with a dinner keynote discussing her efforts to create metrics that give purchasers a better measurement of whole person care, including clinical, genetic, behavioral, and social factors. Audience members remarked that this was a novel approach to quantify what has become accepted correlation in adverse health outcomes.
, , and Stuart Venzke led discussions on Data & Technology, diving into updated federal regulations that present both opportunities and challenges for stakeholders, as well as ways to create corporate strategies that include data and technology, as these issues are no longer optional for anyone in this business. The breakout discussions talked about where we are today vs where we need to be – bridging the gap between data and decision making.
Payment & Risk TOOLS ARE ALIGNING INFORMATION TO ACTION: Achieving meaningful risk-based contracts is possible but the details matter鈥ismatched data and information leads to unequal buying power, which cannot be the case in value-based care.
, , , and Kate de Lisle led discussions on Payment & Risk, including an exciting hands-on simulation exercise that helped participants understand ways to increase premium scores by implementing risk-based payment approaches within the care delivery system; this session provided very concrete takeaways for those who attended by combining a simulation with a discussion on measures of success to improve risk-based contracting strategies.
Amy Bassano and Kate de Lisle discussed their recent publication on the expanded ecosystem of value-based care entities, looking at the 鈥渆nablers鈥� who are working with providers and payers to manage risk. This groundbreaking landscape of this market segment highlighted a set of Guiding Principles to ensure these entities are aligned with CMS, provider, and patient goals. Participants had lots of questions for the presenters and were anxious to read the 红领巾瓜报 .
CARE DELIVERY MEASURES MUST BE TANGIBLE TO PROVIDERS AND PATIENTS: Value-based care requires aligning the right metrics with the right incentives, ensuring providers understand not only WHY but HOW they help improve patient outcomes.
Rachel Bembas, Dr. Jean Glossa, and Dr. Elizabeth Wolff led discussions on Care Delivery Measures, underscoring the importance of involving clinicians in the establishment of outcomes measures, as well as ensuring that the diversity of patient experiences are included. Participants remarked that we have a lot of “messy” data today, so we now have to ask the next set of questions on how we best use the messy data to make an impact?
Former Congresswoman Allyson Schwartz talked about the continuing promise of Medicare Advantage, and the opportunity to convene a new alliance around Medicare quality metrics as well as the increasing pressure to align these metrics across payers. In the closing plenary, she said “We need to define what we want healthcare in America to look like and then go out and get it…. We have to align the measurements and the standards we use so that providers understand what’s needed and it benefits government, taxpayers, and beneficiaries…we should require plans to have risk-based contracting with providers.”
Policy & Strategy HAVE TO STAY THE COURSE TO ALIGN INCENTIVES: Policymakers can help or hinder movement forward to ensure success鈥alue-based care has to be more than a section in an RFP, but part of the entire scope of paying for outcomes-based care delivery.
Governor and former HHS Secretary Mike Leavitt reminded us of the political and policy journey that got value to where it is today, and the unique moment we are in right now that gives us hope as we enter this post-pandemic phase of healthcare spending and policy. He reflected, 鈥淲e are beginning to see regulations and mechanisms to hold people accountable for healthcare costs鈥e have to integrate value and caregiving or we will never get to value.鈥�
Theresa Eagelson, former Illinois Director of Healthcare and Family Services, talked about the opportunity for states to expand value-based care by setting strong expectations through contracting and by thinking differently about policy choices. She reflected on the role of state administrators, “When we sit here and talk about value-based care, do we know what our north star is? Have we mastered what we want to see in RFPs (for Medicaid)? We鈥檙e working on a good FQHC model in Illinois, but should it be just for FQHCs? We need to spend more time together, across payers, across plans and providers and consumers to figure out what success looks like.”
Caprice Knapp and Teresa Garate led a discussion on state and local Policy & Strategy to support integrated care and services that are required to achieve better outcomes. There is a need for services to better coordinate and manage care across social and health services, bringing contracting and payment expertise to more efficiently serve patients. The highly anticipated Medicaid managed care rule can help guide states in updating their approach. Federal analysis of Medicaid data is needed to set benchmarks before we can get to total cost of care approaches.
Amy Bassano and Anne Marie Lauterbach led a discussion on federal policy alignment of Medicare FFS and Medicare Advantage, particularly looking at drug spending and the very real burden of medical debt as a driver of policy change. Participants reflected that half the country is indirectly covered through some public insurance. It’s just being done hyper-inefficiently.
红领巾瓜报 is leading the way on value-based care and is committed to continuing these dialogues to drive local, state, and national change. 红领巾瓜报鈥檚 value-based care expertise draws from our acquisition of and , two firms with deep ties and expertise on policy, strategy and risk-based pricing strategies, as well as recruitment of clinicians and operational experts who have led organizations through this transition. We will continue to advance the dialogue 鈥� and the work 鈥� to drive value as a critical way to ensure that our systems of health and healthcare are more affordable, equitable, and sustainable.
As Medicare, state Medicaid agencies, Medicare Advantage plans, Medicaid managed care organizations, and commercial insurers increasingly adopt alternative payment models (APMs), 红领巾瓜报 (红领巾瓜报) provides a range of innovative and successful approaches to value-based care (VBC).
Our subject matter experts can help you succeed with value-based payments (VBP).
WHAT WE DO
Offer insights for transforming the care delivery model to efficiently deliver optimal patient and population-level health outcomes while successfully managing total cost of care
Ensure quality is the primary goal of
VBP program design and implementation
Develop payment models that align the incentives of payers and providers
Integrate physical and behavioral healthcare, and close gaps related to social determinants of health and health equity
Help clients successfully transition from fee-for-service to value-based payments by providing expertise in change management, analytics, network engagement, and IT infrastructure
Improve the patient and provider experience
Qualify, manage, and monitor health insurance risk
Prepare for and succeed in accreditation for VBP capabilities
ORGANIZATIONS WE SUPPORT
Those engaged in VBP or interested in engaging in VBP
Payers
Providers
Purchasers
Those interested in advancing the broader movement to value
Federal, State & Local Governments
Associations
Foundations
Investment Firms
红领巾瓜报 Can Support You Through All Phases of Value-Based Care
From contract to care plan, we have the experience and guidance tools to support your organization鈥檚 move to value-based care and risk-based contracting.
This graphic showcases the capabilities needed to address the complexities of risk-based contracting and deliver value-based care. As your organization moves from left-to-right along the glidepath to risk, additional strategies and capabilities must be developed. For example, utilizing Institute for Healthcare Improvement frameworks for quality improvement, regulatory and credentialing needs, and specialty access within a clinically integrated network. NEJM Catalyst. (2017). What is value-based healthcare?
Our philosophy involves applying a health equity model to close social determinant gaps and health disparities. Value-based healthcare is all about the care delivery model. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects of emerging/rising risks and incidence of chronic disease, and live healthier lives in an evidence-based way.
Our Comprehensive Approach
Our collaborative approach will be tailored and customized to your needs to help you successfully implement VBP.
Our integrated process is based on the following model:
WHAT 红领巾瓜报 PROVIDES
Determine readiness across key building blocks for moving to value-based payments and achieving continuous improvement across healthcare organizations.
Implementation that includes benchmarks and measurements of success. We facilitate stakeholder input to capture and analyze data from these interactions through surveys, focus groups, and interviews.
Aligning incentives with providers is key to successful value-based care strategies. Understanding methods for identifying and closing gaps in care pathways for common chronic conditions or addressing rising/emergent risks as well as how to create buy-in among providers and other members of the care team.
Including actuarial expertise required for contracting in key areas such as financial projections, reserves, total cost of care analysis, and benchmarking. We provide an assessment of third-party software to support APMs.
Including methods for incorporating whole-person care into clinical algorithms that apply to every interaction with the patient and their families. Integrating behavioral health with physical health and addressing social determinants of health/health-related social needs into VBC programs.
Assist with identifying key performance indicators (KPIs) and quality measurement incentives for pay-for-performance or pay-for- value to support population health outcomes and support total cost of care in various VBP arrangements.
Provide support and consultation on scope of requirements to ensure VBC contract meets delegation requirements for operational, state, CMS regulatory and accreditation requirements.
OUR EXPERTS INCLUDE
Former CEOs, COOs, CFOs, and chief medical officers and other physician executives as well as executive quality leaders of the following organizations:
Providers including hospitals, academic medical centers, physician practices, community health centers, rural health centers, and federally qualified health centers
Medicaid, Medicare, Marketplace and Commercial MCOs
State and federal agencies
In addition, 红领巾瓜报 offers expert actuaries, coders, analytic staff, and clinicians to support your transformation.
Craig Schneider is a leader in developing and implementing payment reform strategies, promoting all-payer claims databases, and engaging stakeholders across … Read more
, March 5-6 in Chicago, is just a few weeks away. Listen to why our speakers are so excited to engage with attendees on value-based care.
, CEO, Purchaser Business Group on Health will deliver the keynote speech on&苍产蝉辫;鈥�The Purchaser鈥檚 Dilemma: Why Employers Should Demand Value (and Why They Don鈥檛).鈥�
Our March 5 dinner headliner , CEO of LovEvolve will discuss her 鈥淲hole Person Index鈥� and how we can collaborate in new ways to transform the healthcare system to deliver better health at a lower cost for all.
New Report Analyzes the Expanding Landscape of Value-Based Entities
Research from 红领巾瓜报 and LP VBP experts segments and sizes the growing enabler market, considering benefits and risks, and proposing guiding principles and policy recommendations for the CMS Innovation Center
A new in-depth 红领巾瓜报 report analyzes the landscape of emerging value-based entities and the implications for accelerating the adoption of accountable care.
In recent years, the value-based care market has expanded to include a variety of risk-bearing care delivery organizations and provider enablement entities with capabilities and business models aligned with the functions and aims of accountable care. Despite their prevalence, there has been little formal research into the role, growth, and impact of these entities to date and publicly available information is limited.
The report, 鈥�Analyzing the Expanded Landscape of Value-Based Entities: Implications and Opportunities of Enablers for the CMS Innovation Center and the Broader Value Movement,鈥� represents a nine-month research effort leveraging the combined VBP policy and market expertise of 红领巾瓜报 and Leavitt Partners, an 红领巾瓜报 Company with support from Arnold Ventures.
The report offers a detailed overview of this evolving landscape by introducing a novel framework for classifying these entities and estimating the size of the market.
The authors interviewed 60 entity leaders, providers, and policymakers and conducted extensive secondary research into approximately 120 organizations, generating report insights that detail the common offerings, partnership models, and growth strategies of these entities. Authors examined providers鈥� experiences selecting and collaborating with enablement partners and the role of these entities within Medicare accountable care models and the broader value movement.
The report concludes by proposing a set of guiding principles to describe the optimal attributes of value-based enablement entities that would be in alignment with CMS, provider, and patient goals. Authors point to steps CMS can take to best engage with this expanded ecosystem in support of its efforts to scale accountable care while ensuring appropriate guardrails to protect patients and providers.
As this landscape evolves and expands, CMS and its Innovation Center should continue to carefully consider how these entities participate in its models while also leveraging these important partners for learning and advancing accountable care.
With its acquisition of Leavitt Partners and Wakely Consulting, along with its strong and growing Medicare policy practice, 红领巾瓜报 is developing a diverse and robust set of solutions for entities engaging in value-based care and payment. In March, 红领巾瓜报 will be devoting its spring event to the topic, with the report authors featuring prominently among discussion leaders and presenters. More information about the Spring Workshop, 鈥淕etting Real about Transforming Healthcare Quality and Value鈥�, can be .
Report authors include Kate de Lisle, Amy Bassano, Jared Staheli, Spencer Morrison, and Melissa Mannon. Data collection and analysis was supported by Thomas Gubbay, Tom Williams, and Lucas Asher.
