The Medicare Access and CHIP Reauthorization Act (MACRA) has neither fueled growth in alternative payment models (APMs) nor has it imposed any significant payment differential based on value in the Merit-based Incentive Payment System (MIPS). Currently, the maximum increase MIPS offers is 1.86%, and in 2018, nearly all (98%) eligible clinicians had a positive MIPS…
Social determinants of health (SDOH) are associated with increased Medicare spending per beneficiary in certain geographic areas, according to a study from the Journal of the American Medical Association. Addressing social determinants of health in these regions can potentially lead to reduced healthcare spending and better quality healthcare. The results show that Medicare spending was higher in geographic locations where…
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…
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…
States that benchmark their healthcare cost growth improve transparency, strengthen primary care and boost alternative payment models, according to a new report. Eight states have implemented or are developing the regulatory and data gathering infrastructure to track annual healthcare cost growth, and more are expected to follow suit. Standardizing how those benchmarks are created and…
To advance value-based care, the Medicare Payment Advisory Commission (MedPAC) has suggested that HHS reduce its number of alternative payment models (APMs) now that it has lessons learned from a wide range of previous demonstrations. “Operating a smaller portfolio of more harmonized models, with more consistent parameters and clearer and more aligned incentives, should more…
Value-based care (VBC) is a crucial step towards improving access, equity, and quality healthcare for Americans. Since the inception of Blue Cross Blue Shield in the 1930s, the US healthcare system has relied primarily on fee-for-service (FFS) payment practices. Essentially, you go to the doctor for a specific need, the doctor serves that specific need,…
Medicare needs to streamline its portfolio of alternative payment models (APMs), the Medicare Payment Advisory Commission (MedPAC) said Tuesday in its annual report to Congress. “CMS [the Centers for Medicare & Medicaid Services] is to be commended for the vigor with which it has approached its mandate of implementing a wide variety of APMs over…
To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously,…
Over the past decade, adoption of value-based payment (VBP) models has increased substantially. The Center for Medicare and Medicaid Innovation’s has launched multiple new models since its authorization, commercial payers have structured almost one-third of their payments as alternative payment models (APMs), and state Medicaid programs have increasingly included payment reforms in their waivers and…