The Global and Professional Direct Contracting Model — a Center for Medicare & Medicaid Innovation (CMMI) creation — has been put on pause. The holdup is just another example of CMMI pumping the brakes on an alternative payment model in the days since the Biden administration took over the executive branch. Broadly, the Global and…
Now that the Biden administration is putting a new team in charge of CMS, advocates for accountable care organizations (ACOs) are preparing to push for changes that they say will bolster CMS’ ACO programs and make risk sharing more palatable. The National Association of ACOs (NAACOS) says that ACOs have worked as intended to slow…
A lot has happened in health care since 2012, when final rules permitted provider-organized ACOs to be the driving force of Value-Based Care under the 2010 Affordable Care Act (ACA). As we pass the ACA’s eleventh anniversary, a dwindling number of Medicare Shared Savings Program (MSSP) ACOs are entering a new phase marked by higher…
The goal of the value movement is to incentivize providers to move away from the traditional fee-for-service model and provide coordinated care for patients with an eye toward improving quality and reducing cost. One key mechanism to achieve this goal is accountable care organization (ACO) models that—because they are offered along a continuum of varying…
Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis. The OCM is a bundled payment model that evaluates the total cost of care for episodes initiated by chemotherapy treatments within six-month performance periods (PP). At the end…
Bolstering the ACA and addressing healthcare inequities perhaps through Medicaid waivers may top the agenda. Experts see a continuation of support of ACOs and growth in enrollment in Medicare Advantage plans. During President Donald Trump’s time in office, Seema Verma headed the CMS, and carried out Trump’s mission of defunding the ACA health insurance exchanges and…
Providers are fiercely opposing changes in two CMS payment rules for 2021, decrying physician rate cuts amid the COVID-19 pandemic, pushing for more telehealth flexibility and urging a stop to a controversial plan to eliminate the list of procedures that can be done on an inpatient-only basis. CMS released its annual proposals for the Physician…
Small physician-led Accountable Care Organizations (ACOs) have shown success in reducing costs while improving quality. But they need more support to continue down that road, according to a new report. Those ACOs would benefit from more guidance and support from the Centers for Medicare & Medicaid Services (CMS), private insurers and other sources as they…
Accountable Care Organizations who are at risk of owing money back to Medicare because they haven’t met spending targets on shared-risk beneficiaries now have more freedom to use telehealth. Under a guidance document released last month by the Centers for Medicare & Medicaid Services, ACOs participating in a Medicare Shared Savings Program that is under…
More accountable care organizations are taking on downside financial risk in the Medicare Shared Savings Program than ever before, with 37% in the program today participating in these arrangements. This is a notable increase in the number of downside-risk ACOs, according to an analysis from Avalere Health. By comparison, just 10% of ACOs assumed downside risk…