Many payers, most notably the Centers for Medicare and Medicaid Services (CMS), have developed new payment models that base reimbursement on a broader bundle of services than traditional fee-for-service payment. The accountable care organization (ACO) program exemplifies the broadest of these new payment models. One of the crucial ACO design features is the extent to…
Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound, provider-accepted and operational Alternative Payment Models (APMs), and attribution is the most critical component of value-based contract design,” the Society of Actuaries recently wrote in…
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…
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…
CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration would apply to eligible clinicians sufficiently involved in Medicare Advantage plans that resemble Advanced Alternative Payment Models (Advanced…
With debate on “repeal and replace” in the rearview mirror, new leadership at the Department of Health and Human Services (HHS), and the threat of rising health care spending undermining economic growth, policy makers are contemplating new models and incentives to speed providers toward value-based care and alternative payment models (APMs). The policy underpinning this…
Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives, benchmarks, and other issues to ensure two-sided risk ACOs continue to generate savings, the Medicare Payment Advisory Commission (MedPAC) recently reported. “Medicare ACOs were created to help moderate…
When we talk about “value” in Value-Based Health Care (VBHC), we’re referring to the high-quality/lower-cost services that buyers want from health care providers. Who are the buyers? Health plans, Medicare and other governmental purchasers, plus employers (for the most part, the term is notably not interpreted to include patients). What do buyers want? “Truth in…
The inaugural MIPS 2017 submission period closed in a fog of uncertainty. The demise of MIPS looms on the horizon, with little discussion of opportunities for improvement. Heath and Human Services Secretary Azar has advocated for removing the quality reporting component of MIPS, while the Medicare Payment Advisory Committee (MedPAC) recommended scrapping MIPS altogether and pushed…
Physician-only ACOs have been leaders in quality and achieving real savings since the inception of the Medicare Shared Savings Program, according to an AMA resource. Here are seven things to know. 1. According to a CMS fact sheet, the number of ACOs participating in the various tracks of the MSSP increased from 480 in 2017…