Australian hospitals rewarded for improving patient experience

At Privia, success breeds growth. Our record MSSP performance shows the power of physician-led, patient-first care and now we’re building on it by adding 120K+ lives through the Evolent ACO acquisition. This strategic growth expands our footprint, strengthens our ability to deliver value-based care at scale, and reinforces our mission: empowering physicians and improving patient lives.

Here is a test for the future of Value-Based Care: Has the current program delivered enough value and incentives to hospitals and provider groups to continue this experiment? The real issue is the short-sided nature of the system: value is derived over time, through the long-term reduction of the total cost of care (TCoC), despite that, in the short term, unit costs may rise. "The 161,765 providers within 103 ACOs participating in ACO REACH will have to decide whether to transition to another ACO model or exit the program altogether if it ends. The National Association of ACOs is lobbying for an extension, but CMS has not said whether that will happen." https://lnkd.in/gcMvrqXY

Value-based care (VBC) is accelerating rapidly in 2025 and will only continue to do so. It is poised to revolutionize healthcare by focusing on outcomes, cost-efficiency, and patient-centered collaboration. With CMS targeting all Medicare beneficiaries in VBC arrangements by 2030, the shift away from fee-for-service is clear. Technologies like AI, real-time data sharing, and telehealth are empowering more personalized, coordinated care — especially by integrating specialists and addressing social determinants of health. However, as multiple companies partner with clinic systems in this landscape, there is a real risk of care fragmentation — a long-standing challenge in U.S. healthcare. The success of these partnerships depends on strong clinical leadership, aligned goals and strategy, robust care coordination infrastructure, and shared accountability to avoid disjointed or inefficient care. Collaboration and transparent data integration are key to breaking down silos, ensuring that patient care journeys remain seamless despite multiple stakeholders. Value-based care’s promise lies in navigating this complex ecosystem with thoughtful design and leadership — transforming partnerships from potential fragmentation sources into engines of integrated, high-value care for patients. #ValueBasedCare #HealthcareInnovation #PatientCenteredCare #HealthTech #IntegratedCare #HealthEquity

As major insurers like UnitedHealth Group and Molina Healthcare grapple with margin pressure from escalating care costs and expensive therapies, healthcare organizations must rethink collaboration models. Senior Executive Healthcare Think Tank experts outline how payer-provider partnerships may evolve—and what strategies health systems and payers should adopt now to preserve access, affordability and quality. See what they have to say ➡️ https://hubs.li/Q03MLBT00 Featuring Eugene Zabolotsky of Health Helper, Mark Francis of Electronic Caregiver, and Feri Naseh, MBA of MeTime Healing

Every system fails without feedback. Healthcare is no different. Until we track outcomes instead of activity, we’re gambling with lives. And once you see the difference, you’ll never look at healthcare the same way again: Right now, the most common metrics we use are activity-based: • Number of appointments booked • Number of prescriptions written • Number of hours billed But none of these tell us the only thing that matters: did the patient actually get better? In fact, in the U.S., hospital readmission rates average ~13.9% across all stays. That means nearly 1 in 7 patients are coming back within 30 days, often for reasons preventable by better care coordination. When systems reward activity, patients get stuck in loops: • Repeat visits with no improvement • Prescriptions stacked on top of each other • Time and money burned on treatments that don’t work It’s not inefficiency, it’s damage. Imagine if instead of counting visits, we tracked what mattered: • Did symptoms improve faster? • Did their quality of life increase? • Did they avoid unnecessary hospital stays? That’s the difference between “sick care” and true healthcare. Because in models that emphasize outcomes: “value-based care”, you see shifts: In some systems, inpatient admissions drop ~30%. In others, readmission rates fall ~4.6% relative to traditional models. That’s not a small change, that’s lives and dollars. Because when outcomes become the metric, everything shifts: • Patients receive better, faster care • Providers finally know what works • Communities rebuild trust in the system • Governments and insurers eliminate waste The entire feedback loop changes. And the biggest win? Better transitions of care Poor discharge planning and communication account for $25–$45B in waste from preventable readmissions (Health Catalyst). That’s money that could be repurposed for prevention, outreach, community care. Other industries already understand this. Why is healthcare, where lives are literally at stake, the slowest to change? It’s not a lack of data. It’s a lack of focus. The system pays for volume, not results. And until we flip that incentive, we’ll keep rewarding noise instead of health. Outcome-based care isn’t just reform. It’s the only way forward. Because without outcomes, we’re not managing health. We’re guessing with lives. Thanks for reading! If you found this useful, follow me for more. Let's build a better future together.

The latest Healthcare Labyrinth Podcast is live. Click below to read. 96. Special Needs Plan Growth and Operational Risks Special Needs Plans are growing explosively in Medicare Advantage, but understanding the operational risks is key. Key Takeaways: -- Plans have been investing heavily in SNPs for several years now and this occurred even with the financial woes many saw in 2024 that led to a massive retrenchment in terms of geographies, products, and benefits in 2025. -- While individual MA plan offerings declined by 6.54% in 2025, SNP offerings increased 8.5% in 2025. -- From January 2020 to September 2025, SNPs grew from 3.687M to 7.909M, a growth of 4.222M or 114.51%. About half of the growth noted above has come since January 2023. -- Dual-Eligible or D-SNPs have dominated the numbers, capturing 3.351 of the 4.222 growth, or 79% of all growth. They grew 118% in the timeframe. -- Chronic Care or C-SNPs grew the most from a percentage standpoint in the timeframe, growing by 1M or 271%. -- Plans are investing due to the CMS Medicare-Medicaid integration strategy, synergies plans see between the two lines of business, and the potential for greater revenue and margin with SNPs. -- But there are risks as well, including the current rate and risk adjustment environment, immature clinical oversight, greater integration, challenges with Star performance for dual eligibles, and the robust audit environment. -- Program audits look at both SNP regulations and a plan’s Model of Care compliance as well. -- Audits no longer limit their focus to health risk assessments and care plan issuance, but go deep into clinical practices, engagement of members with care teams, and how identified problems have been addressed. -- CMS sees the increased use of technology as a dynamic and cost-effective way to identify problems and risks as well as undertake intervention strategies. #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦 https://lnkd.in/euq7Q4gz

The latest Healthcare Labyrinth Podcast is live. Click below to read. 96. Special Needs Plan Growth and Operational Risks Special Needs Plans are growing explosively in Medicare Advantage, but understanding the operational risks is key. Key Takeaways: -- Plans have been investing heavily in SNPs for several years now and this occurred even with the financial woes many saw in 2024 that led to a massive retrenchment in terms of geographies, products, and benefits in 2025. -- While individual MA plan offerings declined by 6.54% in 2025, SNP offerings increased 8.5% in 2025. -- From January 2020 to September 2025, SNPs grew from 3.687M to 7.909M, a growth of 4.222M or 114.51%. About half of the growth noted above has come since January 2023. -- Dual-Eligible or D-SNPs have dominated the numbers, capturing 3.351 of the 4.222 growth, or 79% of all growth. They grew 118% in the timeframe. -- Chronic Care or C-SNPs grew the most from a percentage standpoint in the timeframe, growing by 1M or 271%. -- Plans are investing due to the CMS Medicare-Medicaid integration strategy, synergies plans see between the two lines of business, and the potential for greater revenue and margin with SNPs. -- But there are risks as well, including the current rate and risk adjustment environment, immature clinical oversight, greater integration, challenges with Star performance for dual eligibles, and the robust audit environment. -- Program audits look at both SNP regulations and a plan’s Model of Care compliance as well. -- Audits no longer limit their focus to health risk assessments and care plan issuance, but go deep into clinical practices, engagement of members with care teams, and how identified problems have been addressed. -- CMS sees the increased use of technology as a dynamic and cost-effective way to identify problems and risks as well as undertake intervention strategies. #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦 https://lnkd.in/emtKUQ52

The Joint Commission on the Accreditation of Health Care Organizations plays a global role primarily through its international arm, Joint Commission International (JCI), which accredits, certifies, and partners with healthcare organizations in more than 60 countries worldwide to promote high standards of quality and patient safety. Global Accreditation and Standards Joint Commission International sets internationally recognized standards for healthcare quality and patient safety, serving hospitals, clinics, and health systems outside the United States. Global healthcare organizations seek JCI accreditation to demonstrate a commitment to rigorous, evidence-based practices, quality assurance, and patient care standards comparable to those in the U.S.. JCI is recognized by the International Society for Quality in Health Care External Evaluation Association (IEEA) as meeting the highest global benchmarks for accrediting bodies. Role in Quality and Patient Safety Improvement Through JCI, the Joint Commission provides educational resources, consulting, benchmarking, and leadership in sharing best practices, aiming to enable sustainable improvements and risk mitigation in healthcare organizations globally. JCI-accredited facilities signal quality to medical tourists, insurers, and global partners, thus influencing patient choice and trust in international healthcare. International Reach and Influence Joint Commission-accredited organizations are located in Asia, Europe, the Middle East, Africa, and South America, with more than 1,000 non-U.S. hospitals and healthcare facilities accredited as of 2025. JCI promotes global knowledge exchange, facilitating the adoption of best practices and the harmonization of healthcare standards across different countries and health systems. Limitations and Critiques Joint Commission accreditation is voluntary and acts as a recommendation rather than a legal requirement in most countries. There are ongoing debates about the cost-benefit of JCI accreditation and its direct impact on patient outcomes, especially in highly regulated healthcare settings. In summary, the Joint Commission is a globally recognized driver of quality and safety in healthcare, providing accreditation, resources, and thought leadership beyond the United States to uplift standards and improve patient outcomes worldwide

🩺 CGHS Rate Revision: A Strategic Shift for Healthcare Administrators The recent revision of CGHS package rates, covering nearly 2,000 medical procedures, marks the first major update in over a decade. Following the announcement, hospital stocks such as Apollo Hospitals, Max Healthcare, and Fortis witnessed a notable rise of up to 5%. Beyond market sentiment, this development carries significant implications for healthcare management and policy alignment: 1. Enhanced Financial Viability – Updated reimbursement structures make CGHS empanelment more sustainable, potentially improving hospital margins and liquidity. 2. Broader Access to Care – Revised rates are expected to encourage hospitals to expand cashless treatment under CGHS, enhancing service accessibility for beneficiaries. 3. Strategic and Operational Realignment – The multi-tiered structure, considering accreditation and city categorisation, calls for a reassessment of service portfolios and capacity planning. 4. Policy Sensitivity and Governance – This shift underscores the importance of policy literacy among healthcare leaders, as reimbursement frameworks directly influence institutional strategy and patient equity. The revision represents a crucial intersection of health policy, financial sustainability, and patient access—a reminder that adaptive leadership and informed governance remain central to driving healthcare transformation. #HealthcareLeadership #HospitalAdministration #CGHS #HealthPolicy #HealthcareManagement #PublicHealth

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