Telehealth and other connected health services are not the silver lining to the pandemic that many people thought. Many patients can’t afford or don’t want the needed broadband connection, creating another obstacle for the underserved. In Orange County, Calif., when COVID-19 forced CalOptima to shut down its health and social care center, Elizabeth Lee, director…
The federal accountable care organization (ACO) landscape continues to twist and turn, with one of the most recent developments being the drop of participants in the Medicare Shared Savings Program (MSSP), down from a membership high of 561 in 2018 to 477 at the start of 2021. Leaders at the National Association of ACOs (NAACOS) assert that…
HHS needs to overhaul its approach to value-based payment to ensure widespread practice transformation and rein in Medicare spending, according to a report by the Leonard Davis Institute of Health Economics at the University of Pennsylvania released Wednesday. Experts said the agency needs a new strategy because providers and payers have been too slow to adopt value-based…
A CMS-run care delivery model focused on addressing social determinants of health has effectively identified higher cost and utilization patients while reducing potentially unnecessary emergency department (ED) visits, a new report shows. The Accountable Health Communities (AHC) Model reduced hospital ED visits by 9 percent for Medicare fee-for-service beneficiaries screened for health-related social needs, including housing instability,…
Low-value care spending among fee-for-service Medicare recipients dropped slightly from 2014 to 2018. However, two of the three services that make up the majority of low-value healthcare spending, antibiotic and opioid prescriptions, increased despite a national campaign to promote value-based care, according to a new RAND Corporation study. The researchers analyzed healthcare data of more than…
The Next Generation ACO program, was supposed to end in 2020, but it was granted a one-year reprieve because of the COVID-19 pandemic. The National Association of ACOs (NAACOS) wants that extension to become permanent and says the “Next Gen” ACOs save the Medicare program a lot of money. Former CMS Administrator Seema Verma begs…
Although specialty care drives 40% to 60% of medical costs, specialists are often disconnected from accountable care organizations. Their fee and incentive structures are distinct, and too many care management systems don’t try to bring specialists into the fold. Specialists, however, are critical to care delivery—and they should be viewed as care partners and not…
The Next Generation ACO program, was supposed to end in 2020, but it was granted a one-year reprieve because of the COVID-19 pandemic. The National Association of ACOs (NAACOS) wants that extension to become permanent and says the “Next Gen” ACOs save the Medicare program a lot of money. Former CMS Administrator Seema Verma begs…
ACOs participating in shared savings programs face a number of opposing forces in 2021. From a decline in the number of Medicare beneficiaries to new CMS regulations to force downside risk sooner, ACOs are carefully weighing their options in the year ahead. In fact, the number of ACOs participating in the Medicare Shared Savings Program…
Consumer advocates, accountable care organizations and several experts think CMS’ Center for Medicare & Medicaid Innovation should delay its Geographic Direct Contracting model—dubbed “Geo”—until it resolves a number of issues that could create significant confusion among Medicare beneficiaries and operational and financial challenges for providers. The model builds on the lessons learned from the Medicare…