Tag Archives: value

Wide variations in health care providers’ charges raise questions about the right rate

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Early last month, a report from the Pioneer Institute in Boston showed that Massachusetts consumers could have saved $22 million in 2015 if they got health care from lower-cost providers instead of from the highest-priced health care providers.

In “Analysis of Spending on Shoppable Services in Massachusetts,” researchers wrote that consumers could have saved $116.6 million if the savings were adjusted for inflation over four years.

The researchers analyzed what providers charged in 2015 for 16 shoppable services, such as elective or non-emergent surgery. Continue reading

Who gets the value in value-based care?

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Pictures of Money via Flickr

Last year on this blog, I asked a rhetorical question: Is value-based care a fad? I did not expect to get an answer. But in June I hosted a webcast on this topic and learned that value-based care is not a fad and that what health insurers and health care administrators call value-based care rarely delivers any actual value to patients or consumers.

Instead, when health insurers, physicians, and hospital and health system executives use the term “value-based care,” they most often mean value-based payment. Continue reading

Three CMS proposals would shift basis of payments from volume to value

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

GraphicStock

GraphicStock

Announcements from the U.S. Department of Health & Human Services last week on rules about bundled payments for hip and knee replacement surgeries, home care, and physician payment reform, move the agency forward in its goal to move 50 percent of fee-for-service Medicare payments into alternative payment models by the end of 2018.

To recap: In January, the U.S. Department of HHS announced that it aimed to shift 30 percent of fee-for-service Medicare payments into alternative payment models by the end of the year. By the end of 2018, it plans to have shifted 50 percent to alternative payment models. We explained that under alternative payment models, the federal Centers for Medicare & Medicaid Services rewards physicians, hospitals and other providers who focus on quality and value, such as in accountable care organizations or bundled payment arrangements. Continue reading

Movement away from fee-for-service reimbursements has begun

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

René Letourneau

René Letourneau

Among health plan executives, there’s a lot of talk about moving from volume to value. But identifying what this expression means in practice can be challenging because health plans all define value differently and they are developing ways to deliver more value to their employer and consumer customers.

In fact, the movement to value-based payment is so challenging that while hospitals, physicians, and other providers understand the need to move away from fee-for-service, many are unsure of how to do it, are unable to do it, or are trying to figure out how best to do it, according to a recent article in MedPage Today. Continue reading