Dive Brief: The Biden administration has finalized a rule targeting fraudulent billing in Medicare’s largest value-based care program, after concerning reports of spiking spending on urinary catheters. The anomalous billing had the potential to hurt accountable care organizations, or ACOs, in the Medicare Shared Savings Program by impairing their ability to capture shared savings. ACOs are groups…
Linda Bosserman, MD, PhD, FASCO, FACP, medical oncologist and professor at City of Hope, identifies key gaps in value-based cancer care, emphasizing the need to balance cost and care to improve patient outcomes and quality of life. She discussed this topic at length during her presentation, “Challenges of Providing Therapeutic Excellence in Our Current System,”…
The Centers for Medicare and Medicaid Services has a goal to have all traditional Medicare beneficiaries in an accountable care relationship with a provider who is responsible for their quality and total cost of care by 2030. The National Association of ACOs published ACO Drivers for Success, a report detailing the challenges and best practices…
Download Slides Join ATTAC Consulting Group as we dive into the CMS 2025 Final Rule and proposed Mental Health Parity rule and how regulatory changes may impact providers and plans. We’ll dig into the following: Mental Health Parity: Significant changes will impact provider network operations and reimbursement Provider Network Requirements: Tightened network adequacy standards…
Resistance to change is the biggest barrier to value-based care, Monica Engel, senior vice president of Government Markets at Blue Cross Blue Shield of Minnesota, told Becker’s. “Both organizations need to be dedicated to changing how we act and deliver care,” Ms. Engel said. “For a traditional, legacy provider, change from fee-for-service to value-based can…
Download Slides In August, CMS introduced a new mandatory model: Transforming Episode Accountability Model (TEAM), a bundled payment initiative affecting reimbursement for five key surgical procedures. Key Takeaways:Join our webinar, Unpacking the mandatory CMS TEAM model: Overcome new rules & challenges, on Sept. 24, at 1 p.m. EST. During this one-hour session, you’ll learn:…
The federal government has been increasing efforts to tackle health care disparities by linking payment models with social determinants of health.1 In July, The Center for Medicare and Medicaid Innovation (CMMI) announced a new area-level Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) measure for program year (PY) 2025, replacing the PY2024…
As the United States trails in rankings of health care systems of developed nations, value-based care could improve patient outcomes, but might not smooth out administrative efficiency. This week, The Commonwealth Fund published its latest “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System.” The report shows the U.S. health care is falling…
Since the passing of the Patient Protection and Affordable Care Act (ACA) in 2010, the Center for Medicare and Medicaid Innovation (CMMI) has piloted more than 50 alternative payment models (APMs) designed to improve care across a spectrum of conditions and populations while transitioning away from fee-for-service reimbursement schemes. To date, however, only four of…
Over the past two decades, value-based care has been championed as an alternative payment model that prioritizes quality over quantity. This approach was predicted to be transformative to the health care industry and was set to revolutionize healthcare quality and payments. The idea was so appealing that, in 2014, a substantial 72% of health care…