As we reported in a news article on Sept. 30, “A dispute has arisen over controversial statements made by two prominent healthcare policy leaders around the Medicare Advantage program. On Sept. 30, Donald Berwick, M.D., and Richard Gilfillan, M.D., published an article in the Health Affairs Blog entitled “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2:…
Fee-for-service reimbursement is still an integral part of the healthcare system as providers are scattered along a spectrum of payment models, Emily Sokol, director of research at Xtelligent Healthcare Media, explained on Healthcare Strategies. An Xtelligent Healthcare Media Insights report shed light on how pervasive fee-for-service reimbursement models are in today’s healthcare system. Over 200 providers responded to…
In a highly competitive world, winning requires unconventional thinking. Consider professional sports – MLB scouts understand that finding the right players to add to their roster means looking beyond the surface. And healthcare professionals, especially those participating in value-based care models, have to do the same. Billy Beane, General Manager of the Oakland A’s, knew…
For Rep. Suzan DelBene, D-Washington, a major proponent of legislation in Congress on value-based care, a key driver is making sure that providers have the tools to succeed in payment models and figuring how Congress can help make that happen. DelBene is the lead sponsor in the Value in Health Care Act, bipartisan legislation recently…
Members of the U.S. House of Representatives this week introduced bipartisan legislation to strengthen Medicare’s value-based care models and accountable care organizations (ACOs), among other alternative payment models (APMs). Doctors, hospitals and other providers make up an ACO — the group coordinates care for Medicare patients while limiting extraneous services and preventing medical errors. The better…
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…
New bipartisan House legislation aims to boost the amount of shared savings that accountable care organizations can receive from the federal government to halt a slide in participation that has occurred over the past two years. The Value in Health Care Act reintroduced on Tuesday includes new requirements to study health outcomes for Medicare beneficiaries…
As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately for health insurers, the healthcare industry has lagged in population-based payment uptake. Population-based payment models are models that are detached from fee-for-service reimbursement altogether, as opposed to other alternative…
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…