CMS | VBCExhibitHall Library

Increase in Medicare Advantage Activity to Address Social Determinants of Health, But Barriers Still Remain

August 5, 2021Garrett SchmittNo CommentsCMS, HHS, Medicaid, Medicare Advantage, SDOH, social determinants of health, social needs, Star Ratings, Value-Based Insurance Design, VBID

As Medicare Advantage continues to serve a proportionally higher-risk and more diverse enrollment population, a new report highlights innovative approaches to addressing social determinants of health (SDOH) for Medicare Advantage beneficiaries, while acknowledging barriers that remain. Social determinants of health are non-medical factors that account for up to 55% of an individual’s health outcomes, according…

The Little-Known Agency That’s Trying To Boil The Ocean—A Look At CMMI’s Decade Of Trying To Change Medicare & Medicaid

July 26, 2021Garrett SchmittNo CommentsACA, CMMI, CMS, HHS, Medicare

When asked about government’s influence and impact on healthcare, I like to cite my friend, former Health and Human Services (HHS) Secretary Michael Leavitt, who says, “If you want to change healthcare you have to change Medicare.” Everybody else—the commercial insurers and the providers—will follow. But changing Medicare is hard. As we’ve seen, even with…

The Incentives, Barriers and Levers for Scale in Social Determinants of Health (SDoH)

July 26, 2021Garrett SchmittNo CommentsCMS, incentives, SDOH, social determinants, social determinants of health, value-based care, vbc

Historically, the U.S. healthcare system has evolved based upon the presence of an “event”, i.e., the need for a visit – planned or impromptu – to a medical provider and/or facility. The inefficiencies, glut of utilization and exponentially rising costs that flow from it as funded by the long-standing “fee-for-service” (FFS) payment methodology have been…

The (SGR) Fix Is In: How MACRA Short-Circuited Incentives For Joining Two-Sided Models

July 21, 2021Garrett SchmittNo CommentsA-APMs, ACOs, Advanced Alternative Payment Models, alternative payment models, APMs, CMS, delivery system reform, delivery systems, healthcare payment, incentives, MACRA, Medicare Access and CHIP Reauthorization Act, MIPS, payment systems, SGR

Over the last ten years, policymakers of both parties have identified health care payment reform as a critical national priority. Payment incentives offered by Medicare and other large payers create the environment in which providers must choose between being rewarded for performing more services and procedures, as in fee-for-service medicine or, for efficiently managing the…

The 2022 CMS PFS And QPP Proposed Rule: 7 Things To Know

July 19, 2021Garrett SchmittNo Comments2022 PFS, ACOs, CEHRT, CMS, COVID-19, data exchange, health equity strategies, Medicare, MIPS Value Pathways, MSSP, MVPs, patient-reported outcomes, Physician Fee Schedule, QPP Proposed Rule, Quality Reporting

After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity…

New ACO Playbook: 3 Approaches To Scale Up Data Sufficiency For Value-Based Care

July 14, 2021Garrett SchmittNo CommentsAAPMs, ACO, ACO shared savings, ACOs, APM Performance Pathway, CMS, cost tracking, data sufficiency, Episodes of Care, Quality Reporting

Like every health care organization, your struggles with data may appear never-ending. Like money, there never seems to be enough of it. In this article we’ll take the mystery out of how to realistically gauge your data needs, identify the links between what you want to accomplish as an ACO or medical group in value-based…

CMS Needs to Rethink How Medicare Assesses Quality

July 14, 2021Garrett SchmittNo CommentsCMS, Data, eCQMs, health information technology, healthcare technology, Medicare, MSSP, quality assessment

In less than a decade, accountable care organizations (ACOs) have grown from nothing to caring for nearly 20% of all Medicare beneficiaries. Throughout this period of remarkable growth, quality improvement has been a critical component of Medicare ACO programs. A set of predefined quality measures incentivizes doctors, hospitals, and other providers in an ACO to provide…

CMS Expands Telehealth Coverage in Proposed 2022 Physician Fee Schedule

July 14, 2021Garrett SchmittNo Comments2022 Physician Fee Schedule, CMS, FQHCs, news, Physician Fee Schedule, RHCs, Telehealth

The Centers for Medicare & Medicaid Services’ proposed 2022 Physician Fee Schedule offers some good news for telehealth advocates. The 1747-page draft, released this week, proposes to make permanent some provisions enacted years to address the coronavirus pandemic, while continuing most until at least Dec. 23, 2023 “so that there is a glide path to…

AMGA to CMS: Rethink ACO Financial Risk Advancement in MSSP

July 6, 2021Garrett SchmittNo CommentsACOs, AMGA, APMs, CMS, COVID-19, MSSP, risk management, Value Based Reimbursement

The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a letter to CMS. CMS’ decision to defer the automatic advancement of ACOs in the MSSP and allow ACOs to remain in their current risk level of the BASIC Track’s…

Medicare ACOs Facing Multiple Changes and Challenges

July 6, 2021Garrett SchmittNo CommentsACOs, Alternative Payment Model Performance Pathway, APMs, CMS, data collection, EHRs, Medicare, Medicare ACOs, Medicare Physician Fee Schedule, MedPAC, MSSP, Nextgen, rural glitch

Doctors in accountable care organizations (ACOs), and those thinking of starting or joining one, have had their hands full keeping up with changes in the way Medicare is administering them. ACOs are groups of doctors, hospitals, and/or other healthcare providers that work together with a goal of providing better care at lower cost. As part…