About a year ago Mary Margaret Health CEO Timothy Putnam realized something horrifying: his hospital was never designed for a pandemic. On March 13, 2020, the 25-bed critical-access hospital in Batesville, Ind., saw its first patient with COVID-19. Two weeks later, the hospital was slammed with patients presenting with severe abdominal pain, headaches and backaches, many…
CMS has been quietly reviewing several of its payment models to decide if they will be implemented. Below is a list of updates CMS has released about its payment models: 1. Primary Care First CMS is reviewing the Primary Care First payment model’s seriously ill population component. The payment model component was slated to start April 1,…
Hu founded CarePort while she was a graduate student at Harvard. The care coordination technology company was acquired a second time last fall by Wellsky, a healthcare technology company for $1.35 billion. Senior Editor Peter Wehrwein spoke with Hu about the new CMS Direct Contracting Model, the latest addition to the value-based care menagerie, and what it…
Newly confirmed Health and Human Services Secretary Xavier Becerra needs to reverse a slide in participation among accountable care organizations, the National Association of ACOs (NAACOS) said. The advocacy group wrote in a letter to Becerra on Monday that HHS should also set a national goal to have the majority of Medicare beneficiaries within an ACO…
The Centers for Medicare and Medicaid Services (CMS) has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase quality of care. As the healthcare industry moves toward value-based care delivery, the PCF model will explore if switching from fee-for-service to Medicare performance-based payments could…
When CMS first announced new primary care payment models in April 2019, ACOs understood that their future might be threatened by competition for both physicians and patients. If medical groups could independently contract with Medicare under these models, they would have the advantage of greater control over their physician network, referral arrangements, and clinical decisions….
Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis. The OCM is a bundled payment model that evaluates the total cost of care for episodes initiated by chemotherapy treatments within six-month performance periods (PP). At the end…
Health insurers often pay health plans to manage the care of their members. Good care can help prevent emergencies, such as avoidable trips to a hospital emergency department (ED). Medically complex patients, such as those with behavioral health problems or substance use disorders, tend to have a lot of ED visits. Social determinants of health…
The pandemic has brought many hospitals and insurers both closer together or farther apart depending on how the two responded and interacted during the first year of the crisis. Providers and payers that expanded their cooperative efforts since COVID-19 struck are likely to continue on that path, and so are those who pulled back from…
Researchers at the University of Pennsylvania recently published a white paper that proposes a roadmap for value-based care over the next decade. On March 12, the co-authors gathered virtually to discuss lessons learned over the last decade and their five key recommendations, which include aligning alternative payment models (APMs) across all publicly financed healthcare and giving health equity a…