Your ACO’s most significant costs may seem obvious. CMS and most ACOs have put an enormous emphasis on reducing utilization of hospital facilities and nursing home care to control costs. But your real key to cost reduction is knowing what drives avoidable admissions and stays in the first place. And with 50-60 percent of costs…
Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure noted higher participation in value-based payment models like Institutional Special Needs Plans (I-SNPs) during a recent discussion with HealthAffairs, but also hinted that consolidation of such programs may be needed. “Too many models in too many places that aren’t coordinated with each other,” is how Brooks-LaSure…
Accountable care organizations (ACOs) were understandably disappointed in mid-May when the Centers for Medicare and Medicaid Services (CMS) announced that its Next Generation ACO Model would not be extended into 2022. Launched in 2016, the CMS model provides experienced ACOs with a way to assume higher financial risks and rewards offered through the Medicare Shared…
Partnering with private consulting firms could prompt hospitals to participate in a greater number of episodes in a federal bundled payments program, according to new research. The voluntary Bundled Payments for Care Improvement initiative Advanced Model, or BPCI Advanced, compares spending for specific clinical episodes, like congestive heart failure or sepsis, with benchmarks set by the Centers…
The way to determine the quality of a Medicare Advantage health plan is simple: look at the five-star rating on the Medicare website. However, the Medicare Advantage Star Rating methodology that produces that star indicator is much more complex. A Medicare Advantage plan is a private payer health plan which the federal government funds and…
Extensive research and the pandemic have elevated the importance of addressing social determinants of health (SDOH) to improve health and reduce longstanding disparities in health and health care.1 Social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Prior…
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…
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…
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…
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…