A huge chunk of organizations plan to leave the Medicare Shared Savings Program if they’re forced to take on financial risk, which could slow the government’s transition to value-based care. And it remains unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversees the program, will make any sought-after changes. A recent letter from the agency, obtained by…
Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety of Medicare Advantage plans with more variation of health benefits, specialized cost-sharing designs, and…
ALEX AZAR LAYS OUT VALUE-BASED CARE AGENDA — The HHS secretary’s four stated priorities, presented at a Federation of American Hospitals conference, generally mirror what the Obama administration pushed in its final years in office, POLITICO’s David Pittman reports. The methods for achieving those goals, of course, will likely look different. — Azar priority #1: Allow…
What is CMMI – the Center for Medicare and Medicaid Innovation? The Center for Medicare and Medicaid Innovation (CMMI), also known as the “Innovation Center,” was authorized under the Affordable Care Act (ACA) and tasked with designing, implementing, and testing new health care payment models to address growing concerns about rising costs, quality of care,…
The federal government on Thursday proposed a 1.84% average rate increase for Medicare Advantage plans in 2019, along with other policy tweaks that officials said are designed to strengthen the MA and Medicare Part D programs. The rate increase is a good deal higher than the 0.45% increase the agency approved for 2018. However, it…
There are 58 ACOs in CMS’ Next Generation model for 2018, including 17 new participants, CMS data shows. Most ACOs participating in the Next Generation model are veterans of the Medicare Shared Savings Program and the Pioneer ACO Model. This year, five of the Next Generation ACOs are new to ACO programs, as pointed out…
CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to proposed changes to MA and Medicare Part D, AMGA President and CEO Jerry Penso, MD, MBA, argued that more standardization across…
In late October, the Centers for Medicare & Medicaid Services (CMS) announced that Downers Grove, Ill.-based Advocate Health Care, the largest health system in the state, and its affiliated Medicare accountable care organization (ACO), Advocate Physician Partners Accountable Care, Inc., realized $60.6 million worth of cost savings in 2016. Ranking second in savings of 432…
New medical billing codes for non-face-to-face encounters and alternative payment models are trying to change the way Medicare reimburses for primary care, according to researchers at the Urban Institute’s Health Policy Center. The report, supported by the Robert Wood Johnson Foundation, showed that CMS aims to find the right payment amount and structure to reimburse…