Josh Seidman advises clients on health delivery and payment innovation with a focus on using information technology to guide value-based care models.

He applies his background in quality, health IT, and patient engagement to accountable care delivery system transformation and new payment models.

Prior to joining Avalere, Josh was a managing director at Evolent Health, where he supported large delivery system clients in quality measurement and performance improvement around clinical transformation, patient engagement, and population health management programs. Prior to that, Josh was a director of Meaningful Use at the Department of Health and Human Services in the Office of the National Coordinator for Health Information Technology, the founding president of the Center for Information Therapy, and director of Measure Development at NCQA.

Josh holds a PhD and an MHS in health policy and management from The Johns Hopkins Bloomberg School of Public Health and a BA from Brown University. Josh is a past president of the Society for Participatory Medicine and was a William B. Ziff Fellow for patient engagement with the Center for Advancing Health.

Authored Content

In the fourth episode of this series, Avalere experts discuss the impact of the COVID-19 pandemic on care delivery and the future of telehealth.

Avalere published an abstract in the online Journal of National Comprehensive Cancer Network (JNCCN).

New analysis from Avalere finds that more accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) have assumed downside risk as the program matures, with the greatest growth over the past 3 years.

Avalere’s “Preparation for Shared Decision-Making” (PFSDM) tool aims to help patients with advanced breast cancer (ABC) feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The validation study confirms the acceptability and usability of the tool for women with ABC.

Avalere used a human-centered design approach to adapt a patient-centered tool to help patients prepare to make treatment decisions with their clinicians.

Various national and local health policies aim to address food insecurity through both healthcare and community-based programs.

Avalere will serve as the RWJF Health Systems Transformation Research Coordinating Center to meet patients’ interrelated clinical and social needs.

To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision-making by embedding shared decision-making (SDM) as a routine part of clinical practice.

Paper details recent developments in leading value frameworks, including Avalere’s Focus on Patient Orientation in Value Assessment.

Avalere published a white paper outlining global recommendations to increase the patient centricity of value assessment framework methodology and application.

In 2018, Avalere partnered with CancerCare and Gabrielle Rocque, an oncologist at the University of Alabama Birmingham School of Medicine, to develop the Preparation for Shared Decision Making (PFSDM) tool.

A supplement to Annals was just published that includes research on how to help physicians talk with their patients about costs of care, including a commentary co-authored with Avalere.

CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.

Providers in the Bundled Payments for Care Improvement Advanced initiative began to assume financial risk on March 1, 2019.

Today continues a steady diet of healthcare cost hearings with committees on both sides of Capitol Hill digging into the issue.

Tune in to hear the last episode in our 4-part series that provides clinicians with recommendations for how to overcome common barriers when implementing cost-of-care (CoC) conversations. Peter Ubel will talk with Avalere’s Katherine Steinberg on actionable tips that primary care clinicians can use to help address potential barriers and challenges related to implementing CoC conversations in the clinical setting. Support for this podcast was provided by the Robert Wood Johnson Foundation and the New York State Health Foundation (NYSHealth). The views expressed here do not necessarily reflect the views of the foundations.

Tune in to hear the third episode in our 4-part series that provides clinicians with actionable approaches for integrating cost-of-care conversations into workflow. Nora Henrikson will talk with Avalere’s Katherine Steinberg on 3 pathways that clinicians can use to best integrate cost of care conversations into their clinical workflows. Support for this podcast was provided by the Robert Wood Johnson Foundation and the New York State Health Foundation (NYSHealth). The views expressed here do not necessarily reflect the views of the foundations.

Tune in to hear the second episode in our 4-part series that provides clinicians with actionable tips and a simple framework for how to structure cost-of-care (CoC) conversations with their patients. Susan Perez and Maria Pisu will talk with Avalere’s Katherine Steinberg on strategies that clinicians can use to discuss costs with their patients. Support for this podcast was provided by the Robert Wood Johnson Foundation and the New York State Health Foundation (NYSHealth). The views expressed here do not necessarily reflect the views of the foundations.

Tune in to hear the first episode in our 4-part series that focuses on how clinicians and other care team members can improve the quality and frequency of cost-of-care (CoC) conversations. To kick-off this series, Gwen Darien and Jim Hardee, will talk with Avalere’s Katherine Steinberg on why clinicians should speak with their patients about the expected costs of their care. Support for this podcast was provided by the Robert Wood Johnson Foundation and the New York State Health Foundation (NYSHealth). The views expressed here do not necessarily reflect the views of the foundations.

ACO Experience Again Proves to Be an Indicator of Success

In February, Avalere is releasing a 4-part podcast series that focuses on how clinicians and other care team members can improve the quality and frequency of cost-of-care conversations with patients.

As part of the Robert Wood Johnson Foundation Cost Conversation projects, Avalere led the development of a set of practice briefs that provide actionable resources to healthcare providers about how to improve the value and frequency of cost conversations with patients.

Despite recognition that providers should implement shared decision making (SDM) as standard practice, integration of SDM into regular care delivery remains elusive.

Avalere used a human-centered design approach structured around patient preferences to help guide advanced breast cancer patients.

Today, Avalere published a technical appendix to the PPVF Version 1.0 methodology report, outlining a quantitative method for incorporating patient preferences into value assessments and healthcare decision making.

On April 24, 2018, Avalere experts were joined by Aledade CEO, Farzad Mostashari, MD, to discuss the latest developments coming out of the Center for Medicare & Medicaid Innovation (CMMI).

Avalere experts are joined by Aledade CEO, Farzad Mostashari, MD, discussing the latest developments coming out of the Center for Medicare & Medicaid Innovation (CMMI).

MSSP and CMMI demonstrations vary in budgetary impact but generally show quality improvement.

Incentive payments in upside-only Medicare ACOs have increased federal costs, but data suggest that ACO experience and adoption of two-sided risk could constrain future Medicare costs.

While clinicians have been hesitant to assume risk, bonus payments would result in 9 out of 10 ACOs and their participants achieving a net positive financial impact.

Avalere experts expand on significant priorities for 2018.

Evidence suggests that shared decision-making can play a role in advancing a value-based care delivery system.

Avalere simulation finds that more ACOs will be eligible for earnings if they take on two-sided risk.

Tune in as our experts discuss the key differences making the the Patient-Perspective Value Framework 1.0 (PPVF) unique compared to value frameworks currently in the market.

Blog post features key learnings from the Patient-Perspective Value Framework.

As the industry continues to see a shift from volume to value, Avalere experts examine the future of Medicare's Quality Payment Program under a new administration.

Today, Avalere and FasterCures published Version 1.0 of the Patient-Perspective Value Framework (PPVF).

This week, FasterCures provided Avalere with a second round of seed funding to test, refine and validate the PPVF.

On January 18, 2017, the Centers for Medicare & Medicaid Services (CMS) announced the new Accountable Care Organization (ACO) participants in the Medicare Shared Savings Program (MSSP) for 2017.

Today, the Institute for Clinical and Economic Review (ICER) released an updated version of its Value Assessment Framework.

Avalere and the Robert Wood Johnson Foundation Launch Eight Grants to Improve Cost-of-Care Conversations Between Patients and Clinicians.

Avalere experts discuss the top priorities to focus on as you navigate the new landscape.

Avalere and FasterCures released the first deliverable of the Patient-Perspective Value Framework (PPVF) Initiative at the annual Partnering for Cures Conference.

This summer, the Institute for Clinical and Economic Review (ICER) opened a national call for suggestions on how to improve its value assessment framework. In response, ICER received over 50 comments. On October 4, ICER made 46 of those comment letters public.

In June 2016, in collaboration with FasterCures, Avalere launched the Patient-Perspective Value Framework (PPVF) Initiative to develop a value framework that appropriately incorporates the patient's perspective on value.

Avalere experts say that the impact for most hospitals will be modest.

Last Tuesday, August 2, the Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS final rule

Katherine Steinberg comes to Avalere Health with more than 15 years’ experience in the healthcare arena.

The plans are waiting to see how frameworks will evolve and if physicians embrace them before relying on them to decide which prescription drugs to cover.

Data show gaps in care integration across provider settings following hospital discharges.

Earlier today, the Centers for Medicare and Medicaid Services (CMS) released participation information for its new Oncology Care Model (OCM) slated to begin July 1.

Avalere Supports the Robert Wood Johnson Foundation in Issuing Two Calls for Proposals

On June 1, Josh Seidman participated in a panel discussion hosted by FasterCures to discuss Avalere's collaboration with FasterCures to develop a patient-centric value framework.

One year after Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in a landslide, the Department of Health and Human Services is implementing this legislation to transform physician payment.

The passage of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI) to help advance new payment and delivery models.

With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.

HHS confirms continued movement away from traditional FFS payments, yet significant work remains to move more providers away from upside-risk models and into downside-risk models.

On behalf of The Pew Charitable Trusts, Avalere conducted research to identify current barriers to interoperability and some of the best potential solutions in the current political and business environments.

FasterCures and Avalere partner to develop a patient-perspective value framework.

Hospitals should focus on care after discharge, which drives more than 39 percent of spending.

To what extent do patients currently have access to their own data in their providers’ electronic health records, and what does the future hold for consumer access to their digital health data? Listen to Avalere's Josh Seidman share how far we’ve come with providing patients access to their health data, where there is still room for improvement, and what patients can expect to see in the future.

A new analysis by Avalere examines differences in Medicare spending for episodes of care before and after cardiovascular imaging, colonoscopy, and evaluation and management services. Avalere applied a risk adjustment methodology to account for differences in patient demographics and patient severity across settings. The findings suggest when care is initiated in the typically higher-paying HOPD setting than in physicians' offices and ambulatory surgical centers, the services that follow also result in higher spending relative to when care is initiated in the office setting.

With growing out-of-pocket spending for care, patients are increasingly interested in knowing, upfront, how much their care will cost them, and how it relates to the quality and appropriateness of their care. Yet, various barriers often prevent these conversations from occurring during routine clinical encounters.

The Centers for Medicare & Medicaid Services (CMS) announced that 121 new Medicare Accountable Care Organizations (ACOs) have joined the Medicare Shared Savings Program (MSSP) and Next Generation (Next Gen) ACO models. In addition, 147 MSSP ACOs renewed their contracts. The increase in risk-bearing ACOs and the recently released proposed benchmark rule mark CMS' commitment to shifting from volume to value.

A new analysis by Avalere Health estimates that three proposed policy changes to expand Medicare reimbursement of telehealth and remote patient monitoring (RPM) would collectively decrease federal spending by $1.8 billion between FY2017 and FY2026.

According to a new analysis by Avalere, a prescription requirement for pseudoephedrine-containing products also fuels the growing shortage of primary care physicians, thereby increasing the cost, time, and difficultly of obtaining the treatment for legitimate users.

Pharmacists are increasingly providing direct patient care based on each state's scope of practice regulations in a variety of settings spanning inpatient, outpatient, and community pharmacies. Examples of these direct patient care services include immunizations, wellness and prevention screening, medication management, chronic condition management, and patient education and counseling. While opportunities for pharmacists to provide direct patient care services emerge, options for obtaining reimbursement for these services continue to be limited. Avalere Health assessed the current healthcare delivery and payment landscape to identify factors that can facilitate broader reimbursement of pharmacist services.

How can you position your organization for new payment models that emphasize quality of care over quantity of services performed or therapies sold? Engage patients. In this short video, Josh Seidman, Avalere Payment & Delivery Innovation, defines the key imperatives to creating a successful patient engagement strategy that will bring your organization to the forefront of the industry's transition from fee-for-service to value-based care.

Recently, CMS released a Request for Information (RFI) inviting public comment on three provisions related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)-the Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and Physician-focused Payment Models (PFPMs). Comments are due to CMS by November 17, 2015. We sat down with Avalere's Josh Seidman to discuss what to expect from the RFI.

A new analysis from the National Health Council (NHC) and Genetic Alliance, with research and analytic support from Avalere Health, identifies critical barriers hindering the advancement of meaningful patient engagement and outlines tactical next steps for actionable solutions.

The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a "patch" that they regularly deployed through a "doc fix" for nearly two decades.

Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.

Secretary Burwell set the healthcare community abuzz January 26 when she announced the Department of Health and Human Services' (HHS) plan to set 30 percent of fee-for-service payments to alternative payment models (APMs) by 2016 and 50 percent by 2018.

Avalere analyses show that more than 700 ACOs already operate in the U.S.

By the end of 2016, HHS plans to make 30% of fee-for-service payments through alternative payment models, such as accountable care organizations and bundled payments, and tie 85% of all fee-for-service payments to quality or value. This places increasing urgency on healthcare organizations to make a fundamental shift in their approach to care delivery.

As healthcare leaders and policymakers look to curb spending and improve quality, they should examine models like the Alternative Quality Contract (AQC), according to a new paper by Avalere.

Avalere hosted its 2015 Outlook webinar last week, which featured Tanisha Carino, Lindy Hinman, Ellen Lukens and Josh Seidman.

In 2014 the healthcare industry saw fundamental change in how health plans approach the market, provider consolidation in many areas, a focus on quality-based payments, unprecedented growth in consumer liability for the cost of chronic illness, and a slowing in the rise in healthcare costs.

On Monday, January 26, Secretary Burwell announced a goal to have half of Medicare fee-for-service payment in alternative payment models (APMs) by 2018.

Avalere Health and The SCAN Foundation partner to understand the interplay between medical and non-medical issues. Listen to Avalere’s Sally Rodriguez detail September’s white paper release.

The long waiting game for ACO stakeholders is no more after CMS finally released their much-anticipated proposed ACOs Rule 2.0 on December 1, 2014. Listen to Josh Seidman dive into the most recent CMS Medicare Shared Savings Program (MSSP) Rule.

As stakeholders across the healthcare spectrum continue to wait for CMS’ ACOs Rule 2.0, Avalere’s Josh Seidman takes a crack at pinpointing the much anticipated ACO policy changes.

With something as complex and as political as shared savings models in healthcare, there will always be push-back. But according to Avalere’s Josh Seidman, now is a unique opportunity for Accountable Care Organizations (ACOs) to finally succeed. Josh explains that the current healthcare infrastructure makes ACOs attainable thanks to recent changes, including increased electronic health record use, more provider comfort with comparative performance reporting, enhanced centrality of patient engagement and new incentives that reward accountability and value.

On Feb. 21, CMS enhanced the Physician Compare website to include the addition of quality measures to indicate the performance achieved on a set number of specific metrics.

Emerging payment models will demand that hospitals establish tight and narrow networks of high performing post-acute care (PAC) providers.

Congress is likely to pass another short term doc-fix for CY2014.

The growing pressure to manage patient care post-discharge in an efficient manner will drive significant growth in telemedicine over the next few years.