Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery. As the industry moves away from fee-for-service models and toward value-based care models, CMS has implemented several programs to improve patient care, advance population health, and lower healthcare costs. These value-based…
Better Merit-based Incentive Payment System (MIPS) quality scores were rarely associated with lower rates of hospital complications during the first year of program implementation, according to a study published in JAMA Network Open. Researchers studied a cohort of over 38,000 specialty physicians using CMS’s Physician Compare and Hospital Compare data from 2017, the first year…
After their first year of using the Alternative Payment Model (APM) Performance Pathway (APP) reporting method, participants in the Shared Savings program are spared further challenges as CMS delays the full transition to electronic clinical quality measures (eCQM) and MIPS clinical quality measures (MIPS CQM) and scales back some program requirements. Last year, participants in…
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…
The Medicare Access and CHIP Reauthorization Act (MACRA) has neither fueled growth in alternative payment models (APMs) nor has it imposed any significant payment differential based on value in the Merit-based Incentive Payment System (MIPS). Currently, the maximum increase MIPS offers is 1.86%, and in 2018, nearly all (98%) eligible clinicians had a positive MIPS…
Value-based care (VBC) is a crucial step towards improving access, equity, and quality healthcare for Americans. Since the inception of Blue Cross Blue Shield in the 1930s, the US healthcare system has relied primarily on fee-for-service (FFS) payment practices. Essentially, you go to the doctor for a specific need, the doctor serves that specific need,…
The clock is winding down on the CMS Web Interface, and the reality of mandatory quality reporting via the Alternate Payment Model Performance Pathway (APP) for ACOs in 2022 is setting in. In order for ACOs to develop and execute their APP quality reporting plan in time to avoid catastrophe, it’s imperative to begin evaluating…
The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority…
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…
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…