The past year saw multiple developments that could affect payment reform—a new administration was getting up to speed, the Affordable Care Act (ACA) was debated and its implementation modified through legislative and regulatory changes, and questions were raised about the future of alternative payment models. Despite this, implementation of the Medicare Access and CHIP Reauthorization…
Whether they are called patient navigators, advocates, coaches, or community health workers, non-clinical health workers are becoming increasingly important for patient engagement and care coordination. About half of all healthcare workers are non-clinical staff. This includes community health workers, patient navigators, health coaches, and other individuals who interact with patients but do not dispense medical…
Accountable care organizations were among the key initiatives of the Affordable Care Act, designed to help control soaring Medicare costs. ACOs were expected to save the government nearly $5 billion by 2019, according to the Congressional Budget Office. It hasn’t come anywhere close. On Thursday, the Trump administration proposed an overhaul to the program, which…
Here are 25 major points to note in the CMS Pathways to Success Proposed Rule introduced on August 9th: The redesigned Medicare Shared Savings program is called “Pathways to Success. There are five stated goals Pathways to Success is intended to advance: Accountability, Competition, Engagement, Integrity, and Quality. The CMS projected financial impact of the…
CMS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven things to know about the proposed rule: 1. The redesigned program — which CMS has dubbed “Pathways to Success” — would expand ACO participation…
For many years we have heard health care policymakers from both political parties opine about the need to move to a health care system that pays for the value of care delivered to patients, rather than the mere volume of services. While disagreements may arise on how we get to value, the need for this…
Advanced primary care boosts the savings rate and quality performance of accountable care organizations, research released this week says. Researchers found a symbiotic relationship between ACOs and advanced primary care models such as patient-centered medical homes, the report says. “Systems that already provided advanced primary care had a strong foundation on which to build an…
On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program). Referred to as “Pathways to Success,” this proposed new direction for the Shared Savings Program would redesign the participation options available under the program…
The CMS wants to eliminate zero and low-risk tracks for accountable care organizations to more quickly move them to downside risk. The agency announced Thursday that it is planning to overhaul the Medicare Shared Savings Program by scrapping Track 1 and Track 2 and will launch a Basic track that provides a smaller window for…
Dive Brief: Medicare ACOs with a higher proportion of primary care physicians with patient-centered medical home experience were more likely to generate savings and demonstrate higher quality scores, according to the Patient-Centered Primary Care Collaborative’s (PCPCC) 2018 Evidence Report. Researchers grouped 333 ACOs into quartiles from no PCMH experience (Q1) to 43% PCMH primary care physicians…