To appropriately hold participants accountable for population outcomes, value-based payment models must account for the factors that drive variation in outcomes outside of participant performance. over time, there has been growing recognition that beyond clinical factors, social and economic conditions can play a role in shaping variation of population outcomes that are targeted by value-based…
As CKCC nears its sunset, kidney care leaders urge CMS to preserve a dedicated, nephrologist-led accountable care model for advanced kidney disease. In 2027, Medicare will enter an important transition in its continued evolution toward accountable care. The Long-term Enhanced Accountable Care Organization Design (LEAD) Model will begin a 10-year test intended to make accountable…
Reducing health care spending and improving population health needs a comprehensive approach to replace the current fragmented silo-based approaches. Thoughtful program designs with financial incentives and clear metrics have demonstrated that health care can be delivered at lower cost with similar or better outcomes than currently. Yet significant obstacles remain: Underinvestment in primary care and…
National Association of ACOs hosts leader at fall conference. Accountable care organizations (ACOs) are the best way to deliver health care, the nation’s Medicare chief said. Now federal health leaders and ACO participants must join to recruit practices that are not in an accountable care model. Centers for Medicare & Medicaid Services Administrator Mehmet Oz,…
CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans, but they also shape quality bonus payments to boost benefits. Four stars is the main…
The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program. Overview of the Medicare GLP-1 Bridge demonstration program CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1…
Download Slides In the Fiscal Year 2027 Inpatient Prospective Payment System Final Rule, CMS finalized a national, mandatory expansion of the Comprehensive Care for Joint Replacement (CJR) Model, to be called CJR Expanded (CJR-X). CJR-X will hold all eligible acute care hospitals accountable for 90-day episodes of care following lower extremity joint replacement procedures….
Digital health and artificial intelligence (AI) adoption are accelerating across the health care system, yet their impact on costs and value remains uncertain. Drawing on qualitative interviews and multi-stakeholder convenings with accountable care organizations (ACOs), other accountable providers, technology developers, and policy experts, this analysis examines how risk-bearing organizations are approaching and implementing emerging technologies….
It’s shared savings season and the check has arrived. Now how do physicians divide it up fairly? The Medicare Shared Savings Program check arrives in the fall. It is larger than anyone expected, and within a week, the collegiality of your partnership is under more strain than it has seen in years. Everyone agrees the…
To reduce asthma emergencies, Medical Home Network ACO is replacing Medicaid patients’ gas stoves with electric stoves Medical Home Network (MHN) and the MHN ACO are launching an asthma prevention program that will replace gas stoves with electric stoves for MHN ACO Medicaid patients. Chicago-based MHN is focused on transforming care in the safety net through…