On March 19, 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model—the Accountable Care Organization (ACO) Primary Care Flex Model (ACO PC Flex Model)—which will test primary care capitation in CMS’s permanent ACO program, the Medicare Shared Savings Program (MSSP). Under the model, monthly prospective primary care payments to MSSP ACOs will…
Navigating the Shift: Transitioning from CMS Web Interface to APP As the 2024 performance year ends, MSSP ACOs (Medicare Shared Savings Program Accountable Care Organizations) are bracing for new reporting obligations under the Quality Payment Program (QPP). The Centers for Medicare and Medicaid Services (CMS) is gearing up for a complete transition to digital quality…
A coalition of 11 groups representing accountable care organizations (ACOs) and other health care stakeholders wants the government not to consider “anomalous” Medicare spending that is outside ACOs’ members control when determining if an ACO has exceeded its annual spending benchmarks In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid…
Download Slides Explore the impact of V28 on revenue, uncover key diagnoses, and learn mitigation strategies. With V28 in full swing, it’s a great time to review the experience of our first year. We’ve been digging into the data to understand what it’s telling us about strategies that are successful and unsuccessful in managing…
Valued-based care has become a household name in healthcare. Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker’s to answer, “What is the future like for value-based care in orthopedics?” Note: This response has been lightly edited for length and clarity. Dr. Philip Louie: Very complicated, like…
Download Slides Dr. Sheila M. Magoon, Family Practice provider and clinical expert, will share how her system navigates complexities of rising costs and utilization of their aging patient population. Their strategy consists of pinpointing specific sub-populations based on predicted future risks of utilization, complication, and developing chronic diseases and deploying tailored interventions that reduce…
As noted in the first article in this series, traditional value-based (VBC) care models are largely focused on economic incentives to healthcare providers and facilities. Many VBC organizations lack the infrastructure in place or scale to integrate factors that impact how patients interact with the healthcare system, engage with care providers, or adhere to treatment…
Telehealth has been around for decades, but the COVID-19 pandemic thrust it into the spotlight when patients couldn’t see practitioners in-person. Suddenly, telehealth via video, audio, text, and email became a lifeline, one that’s especially beneficial for patients who have an established relationship with providers, those dealing with chronic conditions, people living in rural areas,…
Since the Affordable Care Act was signed into law in 2010, CMS has been encouraging physician practices to move from a fee-for-service payment model to one that rewards value. It has been testing models that incentivize clinicians to provide preventive, proactive, and appropriate care that improves patient outcomes and experience and decreases unnecessary healthcare spending….
Summary On January 18, 2024, the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services (CMS) announced Innovations in Behavioral Health (IBH), a new eight-year model focused on adult Medicaid and Medicare enrollees with moderate to severe mental health conditions and substance use disorders (SUD). CMS released substantial additional…