A softer form of health care consolidation, where independent primary care practices align in certain Medicare accountable care organizations (ACOs) to negotiate with payers, may lead to higher prices, but not to an overwhelming extent, according to a new study published Monday in Health Affairs. Researchers focused their work on independent practices joining ACOs led by…
The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority…
Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force…
CMS recently named the 53 organizations that are participating in the 2021 performance year for the Global and Professional Direct Contracting Model. The model’s 2021 performance year starts April 1. The goals of the model include allowing more types of organizations to participate in risk-sharing arrangements and build off of Medicare ACO efforts like the…
Industry expert David Smith, Founder and CEO of Third Horizon Strategies, provides an overview of CMS’s value-based initiatives with specific perspectives on the new administration’s Medicare/Medicaid philosophy, the rise of complex care management, and Medicaid Advanced Payment Models. He also shares an update on the core CMS payment models including MIPS, ACOs, and BPCI, as…
The Medicare Shared Savings Program (MSSP) is the largest value based care program from the Center for Medicare & Medicaid Services (CMS) to date. Since its inception in 2012, Accountable Care Organization (ACO) participation has doubled; providing care to over 10 million beneficiaries, generating $1.94 billion in total savings, and earning over $1.47 billion in…
Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many…
One of the enduring conflicts in healthcare, really going back to the early 1970s when the first HMOs were formally recognized under the Health Maintenance Organization Act off 1973, has been the longstanding set of tensions between providers and private health insurers. Of course, there has been tension between providers and the Medicare and Medicaid…
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…
The Center for Medicare & Medicaid Innovation (CMMI) remains committed to moving the health care system towards value-based care in the early years of the Biden Administration, though the center’s leadership is doing some soul-searching on how best to pursue its mission, according to CMMI’s new director Liz Fowler. Fowler made her first public remarks…