Physicians are still getting a lot of their pay from personal productivity despite broader attempts to shift to value-based payment models. An analysis (PDF) from the American Medical Association found that 31.8% of the average physician’s compensation came from personal productivity in 2016. Salary continued to be the dominant method of physician compensation, but productivity was…
In 2013, Earnest Carter, MD, deputy health officer of Maryland’s Prince George’s County Health Department, sought and received grant funding to improve population health in the community. His vision was to involve various local stakeholders and focus on social issues impacting an individual’s ability to live a healthy life. In 2016, Prince George’s partnered with…
In health care, all bundled payment models shift financial and clinical accountability to a single provider-led entity that then is responsible for a budget and the quality of care delivered for any given episode. The entity receiving the bundled payment earns a higher margin if a patient has fewer expenditures but also bears the financial…
Atlanta-based Emory Healthcare recently announced the creation of an accountable care organization (ACO) with retail giant Walmart, known as the Accountable Care Plan. Walmart employees at 55 Walmart, Sam’s Club, and Walmart Distribution Center locations in the metro-Atlanta region have been able to enroll in the Accountable Care Plan since Jan. 1, 2018. The employees…
Five years ago, the term accountable care organization became a trending buzzword. However, as we quickly learned, if you’ve seen one ACO, you’ve seen just that … one ACO. That’s because virtually all ACOs have a unique governing structure and provider participants—from physician-only, to physicians and hospital partners, or hospital and skilled-nursing facilities, just to…
Medicaid accountable care organizations (ACOs) are designed to improve health care quality while delivering more efficient care. But, medical care is only one of several factors affecting health outcomes. Social determinants of health (SDOH), such as living environment and access to healthy food, affect health outcomes and, consequently, an ACO’s bottom line. Because most ACOs…
Taking on the responsibility for patients based on a geographic region could help providers better generate financial savings, according to a new opinion piece in the Journal of the American Medical Association. As federal legislation moves the system away from mandatory participation in payment reform, place-based partnerships may help accountable care organizations more efficiently provide value-based care, the authors from…
Let’s face it. There’s a pretty low bar to meeting Medicare’s ACO Quality requirements. Most ACOs have achieved acceptable quality performance for Medicare Shared Savings Plans (MSSPs). They have not, however, achieved the savings needed to be successful. ACO supporters point to the “Triple Aim” of achieving higher quality, cost savings and good patient experience…
In announcing the forthcoming Bundled Payments for Care Improvement Advanced (BPCI Advanced) program, Medicare has demonstrated its commitment to bundled payments as a value-based alternative payment model (APM). In a prior post, we compared features of the BPCI Advanced to its predecessor program, the Bundled Payments for Care Improvement (BPCI) initiative, and highlighted how certain…
Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety of Medicare Advantage plans with more variation of health benefits, specialized cost-sharing designs, and…