Accountable care organizations (ACOs) have become a major payment and delivery reform since they were introduced as a key component of the Affordable Care Act. Currently, there are more than 1,000 ACOs covering about 33 million lives across all payers—numbers that have steadily increased over time. The ACO model continues to evolve, but it seems…
Beginning in 2019, CMS will allow At-Risk ACOs, including Track 1+ and NextGen ACOs, to buy Stop-Loss independent from CMS’ own mandatory Stop-Loss. So what does this mean to your At-Risk ACO and your bottom-line and profits? This new CMS policy allows ACOs to buy stop-loss protection apart from CMS and its truncated (built in…
Participating in a physician-led accountable care organization can be an alternative for independent physicians who don’t want to consolidate with a hospital or health system. Indeed, physician-led ACOs show promising results and in various studies outperform ACOs led by hospitals and other large medical organizations. They also can provide a way for practices to handle increasing government regulation and can help…
In previous blogs, we have discussed programs whose goals are to improve patient outcomes through quality care while increasing provider efficiency. An additional program provided by CMS to help in these efforts is the Chronic Care Management (CCM) program. CMS has made CCM available to Medicaid ACOs as they seek to create savings for both…
Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals and health systems have flocked to value-based care strategies, such as population health management programs and high-risk patient interventions, the non-profit academic healthcare organization in…
Healthcare organizations are increasingly recognizing the imperative for patient-centered care in value-based payment models, but very few are adequately incorporating the patient voice into their strategies, according to a recent report from the Health Care Transformation Task Force (HCTTF). “The transition to value-based payment has generated more momentum for implementing high-quality, patient-centered care and involving…
In 2017 we saw an evolution in how employees are seeking care. Aligned with a recent National Business Group on Health study that indicates that 96% of large employers are now offering some level of telehealth benefits today, more and more employees were engaging with telehealth in 2017 and learning firsthand that they could receive…
There are 58 ACOs in CMS’ Next Generation model for 2018, including 17 new participants, CMS data shows. Most ACOs participating in the Next Generation model are veterans of the Medicare Shared Savings Program and the Pioneer ACO Model. This year, five of the Next Generation ACOs are new to ACO programs, as pointed out…
Accountable care organizations (ACOs) are provider and payer arrangements established to improve care coordination between primary care physicians, hospitals, specialists, and public or private health payers. The Centers for Medicare & Medicaid Services (CMS), for instance, has created the Medicare Shared Savings Program in which accountable care organizations must meet quality performance benchmarks and reduce Medicare…
CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to proposed changes to MA and Medicare Part D, AMGA President and CEO Jerry Penso, MD, MBA, argued that more standardization across…