Dive Brief: Despite the momentum associated with value-based contracting, a new survey found that payers continue to struggle with the transition to a payment model that rewards value — facing external and internal barriers. HealthEdge’s latest Voice of the Market Survey was based on interviews with 151 health insurance executives and found little agreement about the best…
As part of CMS (Centers for Medicare & Medicaid Services) Administer Seema Verma’s HIMSS19 speech on Feb. 12, she announced a new initiative that will enable MSSP ACOs to retrieve claims data for their beneficiaries. During Verma’s speech, in which she broadly implored the private sector to follow the government’s lead on making health data more accessible,…
Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model. On…
Dive Brief: CMS is launching a project to share Medicare claims data with accountable care organizations in bulk, Administrator Seema Verma announced Tuesday at HIMSS19 in Orlando, Florida. The project, called the Beneficiary Claims Data API (BCDA), will allow ACOs participating in the Medicare Shared Savings Program to retrieve Part A, B and D claims data…
ORLANDO, Fla.—For the thousands of people attending the 2019 HIMSS conference this week, there is no escaping the buzz about the proposed new interoperability rules issued by the U.S. Department of Health and Human Services (HHS) on Monday. Centers for Medicare & Medicaid Services Administrator Seema Verma is the ubiquitous face of the news at the event,…
Starting in 2020, Medicare Advantage plans will be allowed to offer supplemental, “non-primarily health-related” benefits to help certain eligible chronically ill patients with unmet social needs. Put simply, this represents a large source of reimbursement for social determinants of health (SDOH) solutions in the high-growth MA market. While this represents a real opportunity for SDOH…
ACO Repayment Mechanisms – Surety Bonds Medicare Shared Savings Program (“MSSP”) Tracks 1+, 2, and 3; Pathways to Success Tracks C, D, E, and Enhanced; and NextGen ACOs, have two-sided risk. CMS requires these ACOs to provide a repayment mechanism to assure that shared losses can be repaid. Depending on its track, a Pathways to…
Providence St. Joseph Health leveraged data to reduce its knee replacement costs by more than $1 million a year. The Renton, Wash.-based integrated health system first analyzed what drove variation across its 51-hospital network and targeted the use of antibiotic-infused bone cement. Hypothetically, it can stave off infections. But the pre-mixed product added significant cost…
In the rush forward into alternative payment models, including accountable care organization (ACO)-based models, could primary care physicians be in the process of being progressively disadvantaged? A new analysis by a medical researcher suggests that such might be the case, at least when it comes to payment for evaluation and management (E&M) services. Writing in…
Transitioning the U.S. healthcare system from one driven by volume to one driven by value could take another 15 to 20 years, experts say. For the independent physician, there is ample opportunity to consider a leadership role in the evolution by joining an accountable care organization (ACO). Federally regulated, fee-for-service Medicare ACOs are setting the…