There is near-universal consensus that “value-based care” is a good and worthy objective. In any instance when unanimity embraces an idea, a thoughtful person might ask whether there’s true agreement or perhaps just a cone of vagueness that accommodates a variety of opinions and lets eyes of the…
As plans and providers collaborate to manage post-discharge care, they will also need to take heed of the nonclinical variables. Limitations in performing activities of daily living (ADLs) and social determinants of health have as great an impact on health care spending among the elderly as the presence of chronic conditions.
Drug manufacturers have relied on coupons to promote access to branded drugs by reducing patients’ out-of-pocket costs. Insurers and PBMs, on the other hand, have opposed coupons because they undermine the effectiveness of cost-sharing requirements and benefit designs that incentivize cost-effective drug prescribing and purchasing choices.
Population health service organizations (PHSOs) are supplanting management service organizations that gained popularity in the ’90s. PHSOs are emerging as the organizations within health systems that can improve the clinical and financial outcomes of the populations the health systems serve.
The past decade has seen advances in payer-provider collaboration and data sharing that reflect clinical, economic, and administrative alignment. What’s needed now is a deeper level of commitment to drive sustainable improvements in quality and cost.
Despite high need and urgency, patient adherence is low. One might think that puts the onus on patients, but a major reason for this gloomy picture is the severe shortage of mental health professionals across the country—a shortage that’s only going to increase.