Value-based care and reimbursement
The healthcare industry is transitioning from the traditional fee-for-service system to reimbursement structures that tie payment to quality and cost of care. Value-based care and reimbursement aim to improve patient outcomes and reduce healthcare spending while improving the experience for patients and clinicians.
Top Stories
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News
20 May 2025
Value-based care revenue to grow, but risk is a challenge
Healthcare organizations expect higher value-based care revenue in 2025, with 64% predicting growth despite challenges like financial risk and lagging data interoperability. Continue Reading
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Feature
15 May 2025
What MAHA means for the CMS Innovation Center, APMs
Under Trump's "Making America Healthy Again," the CMS Innovation Center is overhauling alternative payment model design to include more downside risk and prospective payments. Continue Reading
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News
03 Jun 2019
Accountable Care Organizations Lower Costs Compared to HMOs, PPOs
Commercial accountable care organizations in California had total costs of care of $4,405 in 2017, compared to $4,453 for HMOs and $4,601 PPOs, a new analysis finds. Continue Reading
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Feature
24 May 2019
How Downside Risk Will Impact Participation in Pathways to Success
ACOs must start weighing if the downside financial risk is worth the reward with the start of Pathways to Success pending. Continue Reading
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News
14 Mar 2019
How Accountable Care Organizations Can Prepare for Downside Risk
Fostering the right culture, implementing analytics, and improving care transitions will boost accountable care organization success with downside risk. Continue Reading
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News
25 Feb 2019
Preparing Providers for Value-Based Care, Consumerism in Healthcare
Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Continue Reading
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News
19 Sep 2018
Patient Attribution Key Component to APMs, Value-Based Contracts
Patient attribution defines a provider’s risk pool in alternative payment models and value-based contracts, and understanding the differences in attribution models is key, actuaries advised providers. Continue Reading
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News
15 Aug 2018
Academic Medical Centers Receive More Value-Based Penalties
A new study shows academic medical centers performed worse than their non-academic peers in value-based penalty programs and the centers had higher costs. Continue Reading
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Answer
16 Jul 2018
A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step
Geisinger Health Plan's CFO views a provider-sponsored health plan as a hospital's "natural next step," but providers need to think long-term with their plan to be successful. Continue Reading
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News
25 Jun 2018
How Addressing Social Determinants of Health Cuts Healthcare Costs
Nutrition programs, housing initiatives, and ridesharing partnerships are some of the ways providers are reducing healthcare costs by addressing social determinants of health. Continue Reading
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News
05 Mar 2018
72% of Medical Groups Oppose Mandatory Alternative Payment Models
Medical groups cited a lack of evidence, diversity among practices, and a negative impact on practice innovation as reasons for opposing mandatory alternative payment models. Continue Reading
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News
08 Jan 2018
3 Strategies to Reduce Hospital Readmission Rates, Costs
Identifying causes, enhancing transitional care, and engaging patients are three ways that hospitals can reduce hospital readmission rates and avoid penalties. Continue Reading
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Answer
10 Aug 2017
Physician Expert, Clinical Documentation Key to MIPS Success
An industry expert advised practices to develop physician-led MACRA implementation teams that emphasize clinical documentation improvements for MIPS success. Continue Reading
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Feature
24 Mar 2017
Best Practices for Value-Based Purchasing Implementation
To implement value-based purchasing, healthcare organizations should ensure their staff have the right tools to manage alternative payment models. Continue Reading
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News
28 Feb 2017
CMS Calls on Stakeholders for Pediatric APM Development Input
Stakeholders can provide feedback to CMS until March 28 on potential pediatric alternative payment model development for the Medicaid and CHIP populations. Continue Reading
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Feature
20 Jan 2017
Exploring Two-Sided Financial Risk in Alternative Payment Models
Incorporating two-sided financial risk is key to making providers more accountable for their care. What do providers need to know before entering these alternative payment models? Continue Reading
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News
14 Dec 2016
Developing Post-Acute Networks for APM Reimbursement Success
Healthcare organizations should develop narrow post-acute networks of top performing providers to maximize alternative payment model reimbursement, Premier stated. Continue Reading
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News
18 Aug 2016
How the Affordable Care Act Impacted Healthcare Revenue Cycle
The Affordable Care Act ushered in changes to the healthcare revenue cycle, including more patient financial responsibility and lower reimbursement rates. Continue Reading
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News
25 Jul 2016
Examining the Role of Financial Risk in Value-Based Care
How does financial risk advance value-based care, and how do providers start to engage with more risk? Continue Reading
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Feature
15 Jul 2016
Preparing the Healthcare Revenue Cycle for Value-Based Care
The transition from fee-for-service to value-based care reimbursement has serious implications for healthcare revenue cycle management. Continue Reading
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News
31 May 2016
5 Ways to Increase Hospital Profitability, Aid Revenue Cycle
Hospitals profitability can be increased by boosting patient satisfaction, reducing readmissions and understanding revenue cycle performance. Continue Reading
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News
19 May 2016
5 Ways to Improve Healthcare Supply Chain Management
Healthcare supply chain management can benefit from using analytics effectively and examining contracts and inventory levels carefully. Continue Reading
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Feature
20 Apr 2016
Using Revenue Cycle Analytics for Effective Value-Based Care
The transition to value-based care requires a familiarity with revenue cycle analytics and population health management techniques. Continue Reading