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…
Download Slides Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and…
Accountable care organizations (ACOs) cannot, and should not, hide from downside risk. Despite the ongoing kerfuffle between CMS’s (Centers for Medicare and Medicaid Services) push for downside risk and the threat of mass exodus by early ACO adopters, downside risk is proving fruitful and gaining momentum. Admittedly, ACOs have legitimate reasons for hesitating. In addition…
The Medicare Shared Savings Program (MSSP), now in its sixth full performance year, is at a significant crossroads. In creating the MSSP, Congress envisioned that Medicare accountable care organizations (ACOs) could moderate Medicare spending and improve quality of care by providers taking greater responsibility for costs and quality. While MSSP ACOs have clearly improved the…
Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives, benchmarks, and other issues to ensure two-sided risk ACOs continue to generate savings, the Medicare Payment Advisory Commission (MedPAC) recently reported. “Medicare ACOs were created to help moderate…
Download Slides This is Part 2 of a two part series and was recorded on 6/19/2018. As with Part 1, this webinar will be informative for those considering taking risk in an ACO, specifically Track 1 ACOs considering moving to a risk-based model in 2019. What was covered in this session: The standoff between…
Accountable care organizations, are a new organization of healthcare, combining some aspects of insurance and health systems. They are collaborations which are paid a capitated rate, based on risk, and provide all care to these beneficiaries. If they show savings beyond what they are paid, they receive about half as an “incentive.” Savings cannot be…
Download Slides Recorded on 6.5.18, this webinar will be informative for those considering taking risk in an ACO, specifically Track 1 ACO’s considering moving to a risk-based model in 2019. What is covered: Risk taking in the context of MACRA The move toward ACO risk: results & analysis Financial protection for your ACO View Part…
Most physician organizations are not prepared for the move to value-based care, and 95 percent CIOs of group practices and large clinics state they do not have the information technology or staff in-house needed to transform value-based care end-to-end, according to a recent Black Book Research. This is driving many physician organizations to increasingly seek…