Mandatory Alternative Payment Model Performance Pathway (APP) reporting begins this year, bringing significant changes for Accountable Care Organizations (ACOs). As we move into this new reporting era, the question isn’t whether to act but how to act effectively. Choosing the right reporting method is critical to ensure compliance and maximize your ACO’s return. The Current…
Download Slides Cost control has been one of the central objectives of Value-Based Care. Providers in ACOs and other APMs are participating in a variety of payment models with a cost control objective that is sometimes seen as secondary to other objectives. Under the upcoming politics of less government and less regulation, however, cost…
Value-based care has had several false starts over the years. But in the next year, several health systems are determined to make progress toward a payment system prizing pay for outcomes over volume. “Our No. 1 organizational change in 2025 is a substantial shift from fee for service to value-based care,” said Danielle Scheurer, MD,…
The Centers for Medicare and Medicaid Services (CMS) has set an ambitious goal to fully transition from fee-for-service models to value-based care by 2030. However, according to Anders Gilberg, Senior Vice President of Government Affairs for the Medical Group Management Association (MGMA), this shift will require significant effort and face numerous obstacles, as he told…
Download Slides Discover the keys to mastering value-based care contracts in this informative webinar! Join industry experts as they delve into effective strategies for contract negotiations, year-round performance tracking, and actionable approaches to streamline contract management in value-based arrangements. Gain valuable insights into measuring and comparing performance across multiple contracts to ensure alignment with…
Value-based care (VBC) is a health care delivery model that has grown increasingly common in recent years. Perhaps unsurprisingly, this growth seems to have attracted the attention of government enforcement agencies. In September 2024, the Department of Justice (DOJ) announced a large False Claims Act (FCA) settlement with a VBC primary care practice. In December…
Clinical Documentation Improvement (CDI) programs play a vital role in Accountable Care Organizations (ACOs), ensuring accurate and comprehensive documentation that supports proper reimbursement, compliance, and quality patient care. With healthcare reimbursement models becoming increasingly complex, ACOs must implement strategies that streamline documentation, reduce errors, and align with Medicare’s risk adjustment models like Hierarchical Condition Category…
Value based care remains a top priority in health care, and physician practices of all types are feeling the pressure from payers to take on more risk. Despite this national trend, many physician practices have been slow to embrace these models, in part due to concerns about the ability to win in risk-based arrangements, while…
Health systems and ACOs: Prepare yourself for the return to cost containment as the central objective of Value-Based Care in 2025. While cost measures have always been part of CMS Value-Based Care quality programs, their impact was small relative to the total MIPS score for physician groups. Likewise, ACO savings look big in dollars but…
CMS has made substantial progress on its goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030. As of January 2025, 53.4% of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider. This represents more than…