Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also…
Download Slides Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and…
Improving preventive care, increasing patient access to care, and addressing societal stigma will be the linchpins in addressing the opioid crisis that ravages the nation, according to a new report from the Surgeon General. The report, Spotlight on Opioids, looks at the national public health crisis that led to 115 opioid-related deaths on any given…
As described in our previous post, the MSSP saw for the first time a net savings for Medicare as calculated based on actual payments to ACOs (including bonuses) versus their benchmarks. The continuing trend of increasing net savings relative to benchmarks is consistent with a similar trend toward greater savings in “counterfactual” analyses that show…
Accountable care organizations are finally achieving real savings for CMS, according to recent figures, with the majority of savings coming from ACOs that have been in the game longer. The longer ACOs are in the Medicare Shared Savings Program (MSSP), the more they save, according to an analysis from Avalere Health, a Washington, D.C.-based healthcare consulting…
As in previous years, MSSP ACOs showed strong performance on quality of care measures. But many of the proposed reforms in the program center on whether a redesign could increase the modest savings that have been estimated by the Medicare actuaries and other researchers in the program to date. In this, the first post of…
Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound, provider-accepted and operational Alternative Payment Models (APMs), and attribution is the most critical component of value-based contract design,” the Society of Actuaries recently wrote in…
New analysis from Avalere finds that accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) achieve higher savings for Medicare the longer they are in the program. ACOs in the MSSP for 4 or more years were responsible for nearly all of the program’s previously reported $314 million in savings in 2017, the…
Nearly 90% of U.S. physicians say at least some of their patients have a social condition that poses a serious impediment to their health whether it be unemployment, lack of education or drug addiction, a new nationwide survey of doctors shows. The biennial survey from the Physicians Foundation shows 88% of physicians have at least…
The lack of electronic health record interoperability and sharing of patient data continue to be major barriers to value-based care in Medicare. That’s the consensus of healthcare stakeholders who testified late last week before the House Energy and Commerce Health Subcommittee. Nishant Anand, MD, chief medical officer for Adventist Health System, said that about two…