Well-intentioned programs that aim to improve population health and social determinants of health sometimes don’t take off as health plans intend. While member adoption may not meet expectations, the lessons learned from these instances are valuable and inform future ideas. A panel of health insurance executives discussed this topic during a session at the Becker’s…
The prognosis of COVID-19 on the US health care system may include yet another devastating outcome: delaying its transition to value-based care. The Centers for Medicare and Medicaid Services (CMS) has stopped accepting applications for new accountable care organizations (ACOs) in 2021. Furthermore, it has amended quality reporting requirements for ACOs, reduced their downside risk, and excluded…
CMS is proposing to change quality reporting standards in the Medicare Shared Savings Program and accountable care organizations are pushing back. In the 2021 proposed physician fee schedule rule released Aug. 3, CMS proposed three main changes related to quality: a new mechanism for ACOs to report quality measures, a reduction in the Medicare Shared Savings Program’s…
The newly published 2021 CMS Physician Fee Schedule and Quality Payment Program (QPP) Proposed Rule reflects our harsh reality: Operate under the constraints of the COVID-19 pandemic, while moving toward uniformity and Risk. That tension is palpable in the Proposed Rule’s “push-pull” of CMS trying to continue to advance a Value agenda while stuck in the mud…
The US Opioid Crisis Continues to Grow In our previous blog Opioid Epidemic, Part 1: The Prevalence of Opioid Use Disorder and Impact of Distressed Communities, we utilized Medicare Part D data (over 40 million enrolled beneficiaries) to highlight the growing prevalence rates across the board in the U.S. In short, the key findings were: Prevalence…
The Centers for Medicare & Medicaid Services (CMS) on Aug. 3 released a rule that proposes changes to the Quality Payment Program (QPP) and Medicare Shared Savings Program (MSSP) for 2021. According to federal officials, because providers must stay focused on the COVID-19 pandemic, the number of significant proposed changes to the programs are limited….
While home-based medical care has been shown to reduce hospitalization rates and lower costs for both homebound and non-homebound populations alike, it continues to be drastically underutilized in the current health care ecosystem. As a result, there are millions of older Americans — especially those living in rural areas — who are going without the…
Alternative payment models (APMs) are taking steps to improve behavioral health, but the models need more to make large strides, according to a study from the University of Washington and Harvard Medical School. The study from published in JAMA Network Open last week detailed the findings of a literature review on 17 APM implementations in mental health and substance…
Talk about down to the wire! On June 3, 2020, CMS finally decided to extend NextGen ACOs for another year. While the program was originally supposed to sunset at the end of 2020, CMS is providing some wiggle room to account for the impact of COVID-19. Given the recent significant increase in Coronavirus cases in…
Dive Brief: Fee-for-service Medicare beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report. The report, released Tuesday by HHS’ Assistant Secretary for Planning and Evaluation, analyzed claims data from January through early June and found FFS Medicare beneficiaries’ use of in-person primary care fell sharply mid-March, while…