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…
Patients receiving primary care outside of their defined accountable care organization (ACO) network drive up costs for ACOs, a recent study from Portland State University said. The Medicare Shared Savings program sparked the growth of ACOs. These payment models intend to reduce healthcare costs while improving patient care through care coordination among a network of participating providers. Those…
Small physician-led Accountable Care Organizations (ACOs) have shown success in reducing costs while improving quality. But they need more support to continue down that road, according to a new report. Those ACOs would benefit from more guidance and support from the Centers for Medicare & Medicaid Services (CMS), private insurers and other sources as they…
Despite interest in addressing social determinants of health (SDOH) to improve patient outcomes, little progress has been made in integrating social services with medical care. Even for accountable care organizations (ACOs) that have been early adopters in addressing social needs, significant difficulties have been experienced in this area. These findings were detailed in the February issue of Health…
Accountable Care Organizations who are at risk of owing money back to Medicare because they haven’t met spending targets on shared-risk beneficiaries now have more freedom to use telehealth. Under a guidance document released last month by the Centers for Medicare & Medicaid Services, ACOs participating in a Medicare Shared Savings Program that is under…
Accountable care organizations have major challenges integrating social services with medical care, including a lack of data on their patients’ social needs and the capabilities of community partners. That’s the finding of a new study published in the journal Health Affairs, based on qualitative data from 22 ACOs. “The ACOs in our sample frequently lacked data about several…
The Next Generation Accountability Care Organization Program appears to be on shaky ground as the Trump administration questions its capacity to generate savings and a potential replacement revs up. The five-year demonstration program will expire at the end of 2020 unless the Department of Health and Human Services Secretary Alex Azar decides to extend it or make…
Despite agreement that the social determinants of health (SDOH) can impact accountable care organization (ACO) success, many see challenges in integrating interventions into practice, according to a new study published in Health Affairs obtained ahead of print by journalists. Specifically, ACOs face challenges in collecting data about patients experiencing key SDOH, creating meaningful community health partnerships, and…