Today, ONC & CMS finalized landmark rules to ensure safe, secure, standardized access to health information. Having spent some time on these issues, I’m pleased to read this White House post that puts these rules in historical context, and celebrates the bipartisan nature of this important endeavor. [...]

Diabetes is a condition that affects more than 1 in 4 Americans age 65 and older.1 Centers for Medicare and Medicaid Services (CMS) estimated that Medicare spent $42 billion more on beneficiaries that have diabetes than it would have spent if those beneficiaries did not have diabetes. Let’s take a look at PMPY (Per Member Per Year) spend breakouts in 2018 [...]

The Centers for Medicare and Medicaid Services (CMS) released the 2018 Financial Performance results on all Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). CMS shared this data for the last six years, contributing to a more transparent, open evaluation of the program, and demonstrating how ACOs are not only increasing overall savings, but striving towards value-based care. [...]

As of February 2018, about 30 million people (or 9.4% of the U.S. population) suffered from diabetes; another 84 million people aged 18 or above had prediabetic symptoms.1 Diabetes is a chronic condition; proper and timely diabetes care management is critical to ensure that people with diabetes can avoid long-term sequelae and maintain their quality of life. [...]

Medicare is the federal health insurance program started in 1965 that is provided for individuals who meet certain criteria. Those who are over the age of 65, younger people who have certain disabilities, or anyone who has End-Stage Renal Disease (ESRD) qualify for Medicare insurance. In 1997 Medicare Advantage (at that time called Medicare+Choice) was signed into law which gave Medicare eligible beneficiaries more [...]

The opioid epidemic is a serious public health crisis that is affecting the nation’s social and economic welfare. In 2017, opioids were responsible for about 130 deaths per day, more than 47,000 yearly. Opioid prescribing rates are three times higher than they were in 1999 while opioid overdoses are an astounding five times higher. How did this happen? [...]

In the wake of the Affordable Care Act (ACA), hospitals have drawn attention from policymakers as key partners in reducing the overall cost of care. Consequently, the effort has led to an enhanced focus on preventing readmissions and reducing unnecessary care. The ACA implemented several policy measures to hold hospitals accountable for what happens to patients post-discharge. [...]

In the last post, we highlighted trends in the migration of beneficiaries between Medicare fee-for-service and Medicare Advantage in the United States. In doing so, we can understand why this is such a hot topic for so many of our members across various markets. We are regularly asked: What can we learn about Medicare Advantage populations [...]

Listen in as Mallory Cary, ACO Operations Director of Universal Health Services (UHS), one of the nation’s largest hospital management companies, and Abbas Bader, Director of Product Development at CareJourney discuss their collaboration on building better and more optimized networks using claims data and insights from CareJourney’s Network Advantage platform.

You […]

CareJourney’s Network Advantage platform is largely built upon the full Medicare fee-for-service claims dataset, but it is used by members to draw insights about population health and quality of care for all Medicare enrollees. While fee-for-service and Medicare Advantage beneficiaries are sometimes considered as two distinct groups, these populations are fluid, as beneficiaries can switch enrollments in any given year. [...]

Signed into law in March of 2010, the Affordable Care Act directed the release of Medicare data to the private and public sectors for performance measurement. Until today, we haven’t had a trusted or transparent measure of costs or outcomes for the healthcare delivery system at the physician level. Most of today’s existing methodologies leverage [...]

The past decade has seen a remarkable increase in the number of lives covered in risk-based contracts. According to a recent article by Leavitt Partners published in Health Affairs, “At the end of the first quarter of 2018, we were tracking a total of 1,011 ACOs representing 1,477 distinct active accountable care payment contracts with public and private payers. [...]

As organizations continue the transition to value-based care, the need to (1) identify, (2) assess, and (3) eliminate wasteful spending continues to be a priority. From the identification perspective, initiatives like Choosing Wisely, started by the American Board of Internal Medicine, help both [...]

The Centers for Medicare & Medicaid Services (CMS) recently held the second annual Blue Button 2.0 Developer Conference on the 54th anniversary of Medicare. There were several key takeaways from the conference [...]

Community-level social determinants of health and economic distress explain some differences in health service utilization and disparities in health outcomes among Americans broadly, and perhaps especially among Medicare enrollees due to their age or disability status. […]