The (SGR) Fix Is In: How MACRA Short-Circuited Incentives For Joining Two-Sided Models

July 21, 2021Garrett SchmittNo CommentsA-APMs, ACOs, Advanced Alternative Payment Models, alternative payment models, APMs, CMS, delivery system reform, delivery systems, healthcare payment, incentives, MACRA, Medicare Access and CHIP Reauthorization Act, MIPS, payment systems, SGR

Over the last ten years, policymakers of both parties have identified health care payment reform as a critical national priority. Payment incentives offered by Medicare and other large payers create the environment in which providers must choose between being rewarded for performing more services and procedures, as in fee-for-service medicine or, for efficiently managing the…

All-Payer Spread Of ACOs And Value-Based Payment Models In 2021: The Crossroads And Future Of Value-Based Care

June 17, 2021Garrett SchmittNo CommentsACOs, Advanced Alternative Payment Models, CMS, COVID-19, Innovation Center, Medicaid, Medicare, MSSP, spending, vbc

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…

ABCs of VBC: CMS Value-Based Initiatives – A Current Review and Future Perspective

May 3, 2021Garrett SchmittNo CommentsACOs, Advanced Alternative Payment Models, Answers Media Network, Azara Healthcare, BPCI, CMS, David Smith, direct contracting, Medicaid, Medicare, MIPS, Third Horizon Strategies, vbc

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…

Leveraging Payment Reforms For COVID-19 And Beyond: Recommendations For Medicare ACOs And CMS’s Interim Final Rule

May 29, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, Advanced APM, APM, APMs, payment reform

The COVID-19 pandemic has significantly challenged clinician practices, hospitals, and all health care delivery organizations. Many such organizations have scrambled to build new capabilities and shift workflows to test, trace, and manage COVID-19 as well as remotely manage chronic conditions for their non-COVID patients. At the same time, health care delivery organizations are facing considerable…

More Physician Groups Lead Accountable Care Organizations

May 22, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models

There were more physician-led accountable care organizations (ACOs) than hospital-led ACOs by 2018, according to a study from Leavitt Partners. Physician-led ACOs accounted for approximately 45 percent of all ACOs in 2018, whereas hospital-led ACOs represented just 25 percent and joint-led ACOs represented 30 percent, revealed the study recently published in The American Journal of Managed Care. The…

Emergency CMS rule provides optimism for alternative payment models

May 15, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, APM, APMs

Hospitals and providers face unprecedented financial pressure amid the COVID-19 pandemic. Providers are losing $1.4 billion daily as they experience significant declines in patient volume, according to consulting firm Crowe. Healthcare executives are responding to the financial declines with workforce reductions, pay cuts and other cost-cutting measures. Debbie Zimmerman, MD, Corporate CMO at Lumeris, a value-based…

The Interim ACO Rule Explained: A Pause, Not A Reprieve

May 6, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, APM, APMs, MIPS

As the coronavirus pandemic continues to upend health care in the U.S., pressure has mounted on CMS to adjust its efforts to drive providers to adopt risk. In response, at the end of last week CMS announced a carve-out of COVID-19 patient expenses from certain reporting requirements. In this round, ACOs were on the receiving…

Applying Sutton’s Law To Alternative Payment Models For The Seriously Ill

August 27, 2019Garrett SchmittNo CommentsAdvanced Alternative Payment Models, Advanced APM, APM, APMs

When asked why he robbed banks, Willie Sutton, the infamous US bank robber, responded “because that’s where the money is.” This quote is the inspiration for “Sutton’s Law,” which recommends prioritizing those diagnostic tests that are most likely to yield a definitive diagnosis and quickly lead to a treatment recommendation. While Sutton’s Law has been…

CMS pushes ACOs to take on risk with overhaul of MSSP: 7 things to know

August 10, 2018Garrett SchmittNo CommentsACO, ACOs, Advanced Alternative Payment Models, AHA, APM, APMs, CMS, MSSP, MSSPs, Pathways to Success

CMS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven things to know about the proposed rule: 1. The redesigned program — which CMS has dubbed “Pathways to Success” — would expand ACO participation…

Supporting the Independent Practice in a Value-Based Care System

July 16, 2018Garrett SchmittNo CommentsAdvanced Alternative Payment Models, APM, APMs, EHR, Independent, Independent Practices, MIPS, QPP, Stark Law

Value-based care is touted as a way of incentivizing providers to achieve the triple aim: delivering high quality care, improving population health management, and lowering healthcare costs. While shifting from a fee-for-service model to a value-based care system has the potential to improve patient health outcomes and save healthcare organizations money, the transition from the…

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