Institutional special needs plans (I-SNPs) are seen by some to be the only path forward for skilled nursing facilities (SNFs) to enter value-based care, however, Brian Fuller, CEO of care coordination company Integrated Care Solutions (ICS), thinks SNFs should get more involved with direct contracting entities (DCEs). A lack of understanding may be preventing them…
CMS has released the proposed rule for the Home Health Prospective Payment System next year. The rule seeks to expand the Home Health Value-Based Purchasing (HHVBP) Model and address health equity across different groups of beneficiaries. The rule released earlier today proposes to expand the HHVBP Model nationwide to shift home health Medicare reimbursement based…
Payers may be prepared to comply with the interoperability rule for the July 1 deadline, but are they ready to adopt healthcare interoperability long-term? For the past couple of years, CMS has pushed the industry to take bigger steps toward standardizing interoperability. “CMS continues to build on its roadmap to improve interoperability and health information…
As part of the 21st Century Cures Act, the federal government will require that all healthcare providers grant patients access to their personal health information starting July 1. The CMS Interoperability and Patient Access final rule requires payers and providers to remove the industry siloes that prevent seamless patient data exchange across the care continuum….
Accountable care organization (ACO) growth has hit a snag again, with the COVID-19 pandemic impacting the number of ACOs in public and private contracts, according to a new analysis. The analysis published in the Health Affairs blog found that ACO growth has plateaued over the last couple of years, starting in 2019 when CMS introduced…
Nationwide, accountable care organizations report that it’s becoming more challenging to do business and the stakes are higher than ever. They are taking on more financial risk as CMS shifts Medicare Shared Savings Program ACOs into downside or two-sided risk tracks. Meanwhile, patients are aging, chronic conditions are on the rise and more specialists are…
One critique of many of the value-based program launched by CMS is that they have been voluntary. That self-selection clouds results, goes the critique, because hospitals (and physician practices) that elect to participate in a program likely have attributes going into the program that will make them successful. As a result, favorable outcomes or spending…
The healthcare industry in the U.S. has spent a whole generation talking about moving from a fee-for-service to a value-based model, focusing more on improved patient outcomes and early interventions rather than disease treatment. This shift has occurred gradually, sometimes purposefully, and sometimes in fits and starts, but overall, it has been slower than expected….
During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…
Medicare needs to streamline its portfolio of alternative payment models (APMs), the Medicare Payment Advisory Commission (MedPAC) said Tuesday in its annual report to Congress. “CMS [the Centers for Medicare & Medicaid Services] is to be commended for the vigor with which it has approached its mandate of implementing a wide variety of APMs over…