On September 14, the Centers for Medicare and Medicaid Services (CMS) released performance results for the seventh performance year (2019) of the Medicare Shared Savings Program (MSSP). Overall, 541 different accountable care organizations (ACOs) participated, and, consistent with our findings in prior years, ACOs continued to show year-over-year improved financial performance, generating $1.2 billion in net savings in performance year 2019 relative to CMS’s…

Telehealth is metamorphosing and payers will have to take steps in order to permanently integrate telehealth coverage as a key form of care delivery. When the coronavirus pandemic struck, Donna O’Shea, MD, chief medical officer of population health management for UnitedHealthcare, and other leaders at UnitedHealthcare watched as the payer’s telehealth claims shot up ten…

Keeping patients in a provider’s network has become even more of a priority as health systems look to rebound from the COVID-19 pandemic, according to a new survey. Almost all of the 138 health system and hospital executives surveyed in January and February said minimizing so-called “patient leakage” was a priority in 2020, which is when…

The Center for Medicare & Medicaid Innovation designed its direct-contracting program to attract providers that didn’t take part in its accountable care models. Experts predicted the model’s financial terms would entice new provider organizations. The Medicare Shared Savings Program “had a core problem: If you did not have an established patient base, you could not…

The coronavirus (COVID-19) pandemic has necessitated an unprecedented level of innovation and redesign. One prominent manifestation is the catalyst of telehealth from fringe to mainstream. The impact of telehealth on quality and cost of care remains largely unknown. As policies facilitating this transition are set to expire with the public health emergency declaration, important decisions regarding…

Medical providers of all types have faced significant challenges to their finances and operations during the COVID-19 pandemic as patient volume declined and expenses for items such as personal protective equipment soared. For accountable care organizations (ACOs), many of which take on greater risk than other providers through value-based care arrangements, the challenges have been…

There is no denying that COVID-19 threw an unexpected wrinkle into value-based care (VBC) contracts—but it might not be exactly the wrinkle we thought we’d see. Initial concerns that COVID-19 might scuttle VBC have calmed, largely due to Medicare’s efforts to work with providers carrying downside risk. In truth, COVID-19 only emphasized providers’ need to…