After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity…
Like every health care organization, your struggles with data may appear never-ending. Like money, there never seems to be enough of it. In this article we’ll take the mystery out of how to realistically gauge your data needs, identify the links between what you want to accomplish as an ACO or medical group in value-based…
More than one-third of U.S. healthcare payments flow through an advanced payment model (APM), such as shared savings, shared risk or capitated payment. Yet for the majority of physician practices, most of their revenue is not tied to risk-based arrangements, leading to significant opportunities to participate in these models. Accountable care organizations (ACOs) can be…
The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a letter to CMS. CMS’ decision to defer the automatic advancement of ACOs in the MSSP and allow ACOs to remain in their current risk level of the BASIC Track’s…
Doctors in accountable care organizations (ACOs), and those thinking of starting or joining one, have had their hands full keeping up with changes in the way Medicare is administering them. ACOs are groups of doctors, hospitals, and/or other healthcare providers that work together with a goal of providing better care at lower cost. As part…
The US health care system is increasingly moving towards value-based care to promote improved health outcomes for Americans. This can be seen across Medicare Advantage Plans (MA Plans), Accountable Care Organizations (ACOs), and Certified Community Behavioral Health Centers (CCBHC), among others. This movement also demands a transformation of reimbursement models to value-based contracting, with a…
Accountable care organization (ACO) growth has hit a snag again, with the COVID-19 pandemic impacting the number of ACOs in public and private contracts, according to a new analysis. The analysis published in the Health Affairs blog found that ACO growth has plateaued over the last couple of years, starting in 2019 when CMS introduced…
Nationwide, accountable care organizations report that it’s becoming more challenging to do business and the stakes are higher than ever. They are taking on more financial risk as CMS shifts Medicare Shared Savings Program ACOs into downside or two-sided risk tracks. Meanwhile, patients are aging, chronic conditions are on the rise and more specialists are…
The current ACO model is, indeed, challenging. Blending both provider and payer functions is fraught with conflict. But the provider-directed model was supposed to function closer to the actual delivery of care, and thereby be more capable of generating change. Instead, ACOs have deployed health plan strategies that were implemented decades ago, which failed to…
During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…