As telehealth gains traction as a way to deliver health care, Medicare reimbursement remains a major obstacle to broad implementation due in part to scoring methodology from the Congressional Budget Office (CBO). Rather than decreasing health care costs, CBO’s scoring methodology assumes that telehealth increases utilization and therefore overall costs. Recent legislation on the Hill, … Read more

On April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) model program took effect, affecting roughly 800 hospitals across 67 markets.  Prior to the program becoming active, Leavitt Partners published a blog post stating, “Time will tell whether hospitals and providers will succeed with quality improvements and savings generation under this new program.” One year into … Read more

Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, … Read more

The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, … Read more

Interoperability within health care has long been a goal within the health care IT ecosystem. Historically, interoperability has been focused on providers exchanging data with other providers under HIPAA. Although advances have been made, true data liquidity between providers, consumers, and caregivers has yet to be achieved. It is essential to find better ways to … Read more

The Government Accountability Office (GAO) recently issued a report outlining five key areas in which smaller, rural physician practices tend to struggle as they shift from fee-for-service reimbursement to value-based care. Given the unique nature of rural medicine, and the fact that value-based payment will continue to grow, it is important to understand these challenges … Read more

It’s clear the President-elect and members of Congress are intent on repealing and replacing the ACA, the specifics of which are still in development. However, it is likely that a potential replacement strategy could include punting health care reform to the states. One plausible way the incoming administration could accomplish this is by significantly relaxing … Read more