The question of whether ACOs should be forced to accept “downside risk” — in effect pay a penalty if they exceed certain spending benchmarks — has bedeviled CMS’ ACO programs and ACO programs in general. Seema Verma, the Trump administration’s CMS director, pushed for more downside risk, and the administration’s Pathway to Success program shortened…
The Medicare Shared Savings Program, the accountable care organization (ACO) model that served 10.6 million seniors in 2020, collectively saved Medicare $4.1 billion last year, and $1.9 billion after accounting for shared savings payments, according to the National Association of ACOs and as recently published in Healthcare Finance. 513 ACOs participated in the Shared Savings Program in 2020, down…
Download Slides During this presentation is discussed how to better manage the more difficult individuals, and get the right people on the bus. How to identify providers that don’t fall in line Reconfiguring your network to manage partners that adversely affect ACO performance Strategies to manage difficult or un-cooperative patients Visit the HealthEC Exhibit…
What a difference a year makes. In Spring 2018, many Accountable Care Organizations (ACOs) pondered a walkout over Medicare plans that included downside risk in ACO financials. Nonetheless, CMS finalized its plans to make provider risk a reality for all ACOs in its Pathways to Success overhaul of the Medicare Shared Savings Program (MSSP). ACOs’ lukewarm reception…
Download Slides What will be covered in this presentation: Current state of value-based payment models Similarities and differences across Medicare Advantage and Medicare patient populations, attribution methods, payment mechanisms, quality metrics, post-acute care pathways, and other concepts for contract negotiation Required resources and infrastructure for maintenance and management. Visit Salient Healthcare Booth
Download Slides As provider organizations prepare for Pathways to Success and determine their best approaches for aligning with CMS’s accelerated risk path, ACO’s have important decisions to make in order to ensure their success under CMS’s value-based initiatives, including how to: – Determine the right performance track and when to select it – Find…
Download Slides Has your Medicare Shared Savings Program (MSSP) ACO taken full advantage of the many waivers of federal fraud and abuse laws, such as the Stark Law and the Anti-Kickback Statute? During the webinar we will discuss the different types of waivers, what they are, which ones matter to you, how to use…
ACO Repayment Mechanisms – Surety Bonds Medicare Shared Savings Program (“MSSP”) Tracks 1+, 2, and 3; Pathways to Success Tracks C, D, E, and Enhanced; and NextGen ACOs, have two-sided risk. CMS requires these ACOs to provide a repayment mechanism to assure that shared losses can be repaid. Depending on its track, a Pathways to…
Alternative payment models have been en vogue in American healthcare for some time now. Payers and providers are increasingly being asked to take on greater financial risk instead of shared savings alone. The latest data out this week shows that 34% of total U.S. healthcare payments were tied to APMs in 2017, up 12% from two…
Many payers, most notably the Centers for Medicare and Medicaid Services (CMS), have developed new payment models that base reimbursement on a broader bundle of services than traditional fee-for-service payment. The accountable care organization (ACO) program exemplifies the broadest of these new payment models. One of the crucial ACO design features is the extent to…