The move to value-based care—where payment for volume of services is being supplanted by payment for outcomes of care—has proceeded with remarkable speed since the Affordable Care Act (ACA) went into law a mere ten years ago. Payment for outcomes increasingly focuses on holding providers of healthcare responsible for total costs of care. Accountable Care…
Groups representing doctors, hospitals, and accountable care organizations (ACOs) are pushing back on changes to quality reporting rules for Medicare Shared Savings Program (MSSP) ACOs that were finalized under the Trump administration. “We have significant concerns about the MSSP quality policies finalized at the very end of 2020,” a group of 11 healthcare organizations, including…
Healthcare costs and low-value care tend to increase when hospitals acquire physicians, new studies published in Health Affairs show. The number of diagnostic and lab tests performed in hospitals versus unaffiliated facilities increased after doctors were acquired by hospitals, which inflated healthcare costs, according to an analysis of 30 million imaging procedures and 341 million…
CMS recently named the 53 organizations that are participating in the 2021 performance year for the Global and Professional Direct Contracting Model. The model’s 2021 performance year starts April 1. The goals of the model include allowing more types of organizations to participate in risk-sharing arrangements and build off of Medicare ACO efforts like the…
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…
The Medicare Shared Savings Program (MSSP) is the largest value based care program from the Center for Medicare & Medicaid Services (CMS) to date. Since its inception in 2012, Accountable Care Organization (ACO) participation has doubled; providing care to over 10 million beneficiaries, generating $1.94 billion in total savings, and earning over $1.47 billion in…
Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many…
A robust hospice mergers and acquisitions market is showing no signs of slumping as interest among strategic buyers and private equity investors ramps up. A provider’s performance within evolving value-based payment models may become a factor that potential buyers consider when eyeing a hospice acquisition, particularly as it pertains to their quality and outcomes data….
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…