In late July, the Center for Medicare and Medicaid Innovation (CMMI) announced updates to the ACO Realizing Equity, Access, and Community Health (REACH) model beginning in performance year (PY) 2025.1 This announcement coincided with the recent publication by CMMI of the Global and Professional Direct Contracting (GPDC) Model PY2022 Evaluation Report, which cites some of the early…
The Biden administration wants to change how benchmark payments to accountable care organizations are calculated to make it easier for providers in the Medicare Shared Savings Program (MSSP) to qualify for savings. Leaders in the Centers for Medicare & Medicaid Services (CMS) outlined several changes they are pursuing to get more providers involved in value-based…
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The Biden administration is redesigning the controversial Direct Contracting Model to add new requirements to tackle health equity and ease progressive lawmakers’ concerns over the role of private equity. The Centers for Medicare & Medicaid Services (CMS) announced Thursday that the professional and global Direct Contracting Model will transition in 2023 to the Accountable Care…
Are 66 new accountable care organizations (ACOs) in a year a sign of progress or a disappointing result? That depends on who you ask. CMS announced last week that 66 additional ACOs joined the Medicare Shared Savings Program (MSSP) for ACOs in 2022, bringing the total up to 483 ACOs. However, that number is only…
Medicare’s Accountable Care Organization (ACO) Investment Model (AIM) provided up-front funding to forty-one small, rurally located ACOs to encourage their participation in the Medicare Shared Savings Program. We estimate net savings to Medicare of $381.5 million over three years, driven by utilization reductions in inpatient and other institutional care and by the absence of shared…
Medicare population-based payment models, broadly known as accountable care organization (ACO) models, of which the Global and Professional Direct Contracting Model (GPDC) is an example, were launched out of recognition of two largely inherent weaknesses of fee-for-service: FFS does not promote efficiency, nor does it promote equity. The Centers for Medicare and Medicaid Services (CMS)…
The question of whether ACOs should be forced to accept “downside risk” — in effect pay a penalty if they exceed certain spending benchmarks — has bedeviled CMS’ ACO programs and ACO programs in general. Seema Verma, the Trump administration’s CMS director, pushed for more downside risk, and the administration’s Pathway to Success program shortened…
Accountable care organization (ACO) success depends in part on a broad network of health information exchange (HIE) partners to effectively coordinate care. Our study illustrates that although ACO participation broadens HIE networks, the effects accrue differently across markets with varying levels of ACO penetration. ACO hospitals in high–ACO penetration markets increase their HIE network breadth…
As we reported on Wednesday, Jan. 12, “The top officials at the federal Centers for Medicare and Medicaid Services (CMS) on Tuesday, Jan. 11, made a major public statement regarding the goal of moving the healthcare system towards health equity, and a major component of that statement focused on leveraging Medicare’s value-based programs, particularly those…