CMS recently named the 53 organizations that are participating in the 2021 performance year for the Global and Professional Direct Contracting Model. The model’s 2021 performance year starts April 1. The goals of the model include allowing more types of organizations to participate in risk-sharing arrangements and build off of Medicare ACO efforts like the…
Industry expert David Smith, Founder and CEO of Third Horizon Strategies, provides an overview of CMS’s value-based initiatives with specific perspectives on the new administration’s Medicare/Medicaid philosophy, the rise of complex care management, and Medicaid Advanced Payment Models. He also shares an update on the core CMS payment models including MIPS, ACOs, and BPCI, as…
Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many…
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…
In response to questions from stakeholders, CMS published a calendar March 9 of key dates for the Medicare Direct Contracting Model. CMS’ Innovation Center unveiled the Direct Contracting Model in April 2019 as part of an initiative that includes several new payment options for healthcare organizations. Directing Contracting includes two payment model options aimed at reducing expenditures and improving…
What if your best route to viability was the high-risk path you feared the most, because that failure might destroy you? That’s the question Accountable Care Organizations (ACOs) have been asking this week—whether to participate in Medicare’s new Direct Contracting (DC) initiative. With a shift in payments from Fee for Service (paid per-provider service), to…
In this webinar, Ms. Theresa Hush discusses the following followed by a Q&A session: How the Value-Based Market is shaping up to compete between Medicare Advantage, ACOs, Primary Care First practices and Direct Contracting Groups What represents “true competition” for ACOs, versus disadvantages? · What brand or other competitive advantages does Direct Contracting have…
Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. Direct Contracting and Primary Care First are two of these models announced by CMS to help encourage providers and other eligible professionals to shift from FFS to…
In an attempt to improve patient outcomes and reduce care costs, ACOs in value-based care models across the country have devoted significant attention to the inpatient setting—focusing care management resources on inpatient discharges in particular. This is understandable, given the risk associated with that transition of care and potential for 30-day readmissions, which impact ACOs…
Members of the nation’s largest association for accountable care organizations have asked CMS to make some suggested changes to the new direct contracting payment models and release additional details. Not doing so could “derail” the new payment reform, according to the National Association of Accountable Care Organizations (NAACOS). CMS released first details about the direct contracting…