If you’re participating in the Merit-based Incentive Payment System (MIPS) or MIPS Value Pathways (MVPs), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final score, the numbers don’t quite add up. For many providers, this discrepancy can lead…
Value-based care is transforming the health care landscape as some health systems shift focus toward outcomes-driven payment models. In this evolving paradigm, physicians and other health professionals are rewarded for improving patient health outcomes rather than the volume of services they deliver. This shift is designed to enhance care quality, reduce costs and improve patient…
The news coming out of the Centers for Medicare & Medicaid Services (CMS) this week was all good. What might that mean in the context of an uncertain and complex political landscape around healthcare generally and around value-based contracting more specifically? Well, to begin with, the news coming out of the federal government on Oct….
Prevention is better than cure — this age-old adage continues to guide the healthcare industry as it moves from volume-driven to value-based care models. In value-based care models, healthcare providers are paid based on the quality of care they provide, measured by clinical outcomes, patient and provider experience and the cost of care. According to…
The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program (Shared Savings Program) continues to save Medicare money while supporting high-quality care. The Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the Shared Savings Program’s history. In addition, Shared…
Value-based care remains a top priority in the shifting landscape of US health care, as emphasized during a recent session at the National Association of Accountable Care Organizations (NAACOS) fall conference. The discussion brought together payers and providers to explore the challenges and opportunities in improving patient outcomes while reducing health care costs, with a…
The past couple of years have been rocky for companies looking to disrupt the traditional primary care model — with top retailers Walmart and Walgreens announcing that they’re winding down their primary care operations significantly. Others still stand, though the jury is out on whether they can master the tough unit economics that come along…
Download Slides If you aren’t prepared for APP Reporting because you still think that you can duck APP Reporting with a revised Final Rule, don’t put money on it! You’ve lost a lot of lead time, but you still have options for APP Reporting. It’s time for weighing last minute options to meet requirements with the most economical and efficient APP…
The famous quote “What gets measured, gets managed” is often incorrectly attributed to business guru Peter Drucker. Although Drucker may not believe that maxim entirely, when it comes to value-based care (VBC), only care quality that can be measured and reported matters. Whether it is capitated, bundled, pay-for-performance, or hybrid VBC reimbursement models, the Centers…
Inherent in their design, Accountable Care Organizations (ACOs) are responsible for the total care of their assigned patient population. Their savings are based on the overall quality, quantity, and cost of care their beneficiaries receive. This alone is no easy feat. Yet, for those ACOs participating in Centers for Medicare and Medicaid Services (CMS) programs,…
Across late August 2024, the Centers for Medicare & Medicaid Services (CMS) recently finalized the Transforming Episode Accountability Model (TEAM) in the Hospital Inpatient Prospective Payment System Final Rule. This is CMS’ latest attempt to transition all traditional Medicare beneficiaries into an accountable care relationship by 2030. Specialty care strategies are an important piece of…
In its first three years of operation, Medicaid’s primary care-focused Accountable Care Organizations (ACOs) in Massachusetts showed “no clear evidence of success” in improving asthma care for children, according to research led by the University of Massachusetts Amherst and UMass Chan Medical School-Baystate Health. The study, published recently in JAMA Pediatrics, compared the asthma care…