Strengthening Payer-Provider Partnerships in Medicare Advantage Plans

Accountable Care Organizations (ACOs) have made great strides in enhancing patient care and reducing costs, saving $3.1 billion in 2023. The recently released report based on ACO performance in 2023 (PY2023) provides valuable insights into where ACOs are excelling. In this episode of Value-Based Care Insights, Dan Marino sits down with Sarah Kachur PharmD, MBA, BCACP, Executive Director of Strategy and Solutions at Johns Hopkins Population Health Analytics, to discuss the key findings of the report and what they reveal about the future of ACOs. Gain insights into the priorities of the most successful ACOs (in PY 2023) and their predictions for changes and challenges in 2025 and beyond. LinkedIn https://www.linkedin.com/in/sarahgracekachur/ [email protected] Hopkins ACGs: https://www.hopkinsacg.org/ Illustra Health from Johns Hopkins: https://illustra.health/

Care management is critical, especially for individuals with chronic conditions like dementia, because it ensures coordinated, comprehensive, and individualized care. Currently, more than 6.7 million Americans are living with dementia and Alzheimer’s disease, and this number is projected to continue rising. While the impact of the disease on individuals is widely recognized, the personal and financial burden it places on caregivers is less often highlighted. Today, on Values-Based Care Insights, Dan Marino sits down with JVS Health’s CEO Vanessa Guzman and Co-founder Seth Hyman to discuss the GUIDE Model, a Centers for Medicare & Medicaid Services (CMS) supplement for caregivers of patients with dementia and Alzheimer’s disease. Gain insights into the valuable services within the GUIDE model that can support and benefit individuals living with dementia and their unpaid caregivers.

This year, 2024, presented significant challenges for clinically integrated networks (CINs) delivering value-based care, with the disruption from Medicare Advantage reaching widespread levels. As we look toward 2025, it is crucial for CINs to reflect and gear up for success in the coming year by focusing on risk-based contracting, engaging specialists, and investing in care management. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Will Faber, to tackle several challenges, including the lack of structure among commercial payers to effectively handle value-based contracts and obstacles in negotiating such contracts with specialty providers. Gain insights into strategies and data utilization that will position your provider organization for success in 2025.

Success in the operating room is critical to the financial health of many healthcare organizations, with perioperative services contributing up to 75% of primary revenue streams. Effective perioperative care relies on skilled nurses who balance patient care while collaborating with other teams. In this episode of Value-Based Care Insights, Dan Marino sits down with Cindy Mahal, Chief Administrative Officer of Providence Saint Joseph Medical Center, to explore the challenges nurses face in achieving alignment and how to overcome them. We’ll uncover insights into key strategies administrators can implement to empower nurses, giving them a voice and enabling them to not only align but also lead.

A coherent and consistent approach to evaluating and optimizing surgical patients not only minimizes avoidable harm and complications but also impacts inefficiencies such as case cancellation, delayed case starts and turnover. Furthermore, avoidable complications are increasingly costly through post-acute care utilization, readmissions and never events. Facilities, surgeons, anesthesiologists, patients and families share an interest in doing better from the very beginning of the surgical journey. On today’s episode of Value-Based Care Insights, Daniel Marino explores how to identify and capture opportunities to streamline care and is joined by Alex Hannenberg, former President of the American Society of Anesthesiologists and Adjunct Clinical Professor of Anesthesiology at Tufts School of Medicine, and Art Boudreaux, Professor of Anesthesiology and Perioperative Medicine at the University of Alabama, Birmingham. Gain insights into the importance of aligning and standardizing perioperative processes, and how leveraging data can help reduce inefficiencies, reduce costs, and improve patient outcomes.

Care management is crucial for adding value to value-based care, but gaining stakeholder buy-in on its significance can be challenging. While the return on investment for care management strategies is undeniable, the delayed realization of these returns can be daunting for financial leaders. In this episode of Value-Based Care Insights, Dan Marino sits down with Lisa Stockdale, the Director of Value-Based Care at Silver Cross Health Systems, to look at challenges, as well as the benefits, in implementing successful care management programs. Gain insights into the importance of leadership buy-in, technology, and reinvestment in effective and cost-saving care management programs.

Certain specialties, such as primary care, are generally better positioned to shift to value-based care. Specialists, particularly cardiologists, encounter challenges when transitioning from fee-for-service to fee-for-value. To succeed in this shift, they must rethink their approach to patient care. In this episode of Value-Based Care Insights, Dan Marino sits down with Dr. Sameer Sheth, a board-certified cardiologist who helps specialists transition to value-based care by focusing on a patient-centric approach to medicine. Gain insight into the healthcare provider ecosystem and how data and tools, patient engagement, and communication support the shift from volume-based to value-based care.

Developing a strategic plan is crucial for the success of thriving healthcare organizations, but creating and adhering to the plan can be challenging. In this episode of Value-Based Care Insights, Dan Marino sits with Annette Kenney, a former healthcare Chief Strategy Officer and strategic planning consultant. Annette unlocks how healthcare organizations can develop a strategic planning process that includes input from all stakeholders, including the communities they serve. Uncover insights into how to transform a strategic plan into an actionable workplan that prioritizes activities and drives real success.

Academic medicine providers are increasingly depending on their clinical practices to fund their education and research divisions. How do academic medical providers balance financial performance with clinician and community needs amidst competing missions that challenge their business models? In this episode of Value-Based Care Insights, Daniel Marino sits down with Dr. Joseph Bosco, Professor and Vice Chair of NYU Langone’s Health Orthopedics, and Jeff Peters, a national expert in growth and service line strategies, to explore how academic medicine is addressing conflicting missions across their enterprise. Gain insight into growth models in academic medicine that prioritize clinician and geographic accessibility to keep patients in-network, while maintaining a strong focus on research, education, and quality care.

The challenges posed by Medicare Advantage adoption have led numerous healthcare providers to exit the space altogether, despite the fact that 34 million Medicare patients are enrolled in Medicare Advantage plans. In this episode of Value-Based Care Insights, we sit down with Cliff Frank, a national expert on payer contracting, to delve into the complexities and hurdles healthcare providers face with Medicare Advantage plans, and explore how their responses impact both staff and patients. Gain insight into how geography and legislation influence the short- and long-term implementation of Medicare Advantage, and discover strategies for healthcare providers to safeguard patients from confusing plans and hidden costs.