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Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO Model

September 30, 2021Garrett SchmittNo Commentsdirect contracting, Medicare, Medicare Advantage, MSOs, PCPs, Risk, SPACs

Given an Orwellian title, Direct Contracting, launched by Center for Medicare and Medicaid Innovation (CMMI), was anything but direct. “Indirect Contracting” would have been a far more accurate name, since the cornerstone of the program was CMS’s opening the door to non-provider-controlled “Direct Contracting Entities (DCEs)” to become the fiscal intermediaries between patients and providers….

Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game

September 29, 2021Garrett SchmittNo Commentsdirect contracting, Medicare, Medicare Advantage, MSOs, PCPs, Risk, SPACs

While the COVID-19 pandemic rages, the past two years have seen another epidemic of a far different type—in financing and acquisitions of firms focused on serving Medicare beneficiaries. These firms include physician practices, notably primary care practices (PCPs); management services organizations (MSOs) that aggregate practices; and Medicare Advantage (MA) insurers. In this arena, the combined…

How Redesigning Healthcare Supply Chains Will Drive Value-Based Care

September 9, 2021Garrett SchmittNo Commentscentralized value analysis, COVID-19, Data, outcomes, pandemic, Risk, risk sharing, stakeholder interests, Stakeholders, supplier partners, supply chains, value analysis, value-based care, vbc

The COVID-19 pandemic compressed a decade of healthcare transformation into mere months. Healthcare leaders have been challenged with rethinking every aspect of the business, from how care is delivered to planning for the workforce needs of the future. At the same time, consumers continue to be a driving force in shaping healthcare’s mission. Today’s healthcare…

New ACO Playbook: Three Touchstones For ACO Viability

May 13, 2021Garrett SchmittNo CommentsACOs, alternative payment models, community, coordination of care, Data, Fee for service, growth orientation, Hospital led ACOs, Medicare ACOs, MSSPs, physician-led ACOs, Primary Care First, Risk, technology, vbc

Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force…

How Fowler Plans to Refresh CMMI’s Value-Based Care Vision

April 20, 2021Garrett SchmittNo CommentsACA, alternative payment models, Biden, CHART, CMMI, COVID-19, Fowler, Global and Professional Direct Contracting Model, health equity, NAACOS, Risk, vbc

The healthcare system is at a critical point in its transition to value-based care a decade after implementation of the Affordable Care Act and its Center for Medicare and Medicaid Innovation (CMMI), according to CMMI’s newly minted director Liz Fowler, PhD, JD. “The goal [of the ACA] was to create a system that rewards better…

Can Hospitals Still Lead Health Care Under Risk?

January 22, 2020Garrett SchmittNo CommentsACOs, Hospitals, Risk

As the millennium’s third decade begins, Risk has taken hold as THE strategy for tackling health care costs. Virtually overnight (in health care years) the industry has moved—albeit not uniformly—to accept Risk. This transition is already beginning to impact hospitals and hospital-based systems, and raises serious questions about the viability of their role as the…

37% of ACOs are taking on downside risk

January 21, 2020Garrett SchmittNo CommentsACOs, CMS, Downside Risk, Medicare Shared Savings Program, MSSP, Risk

More accountable care organizations are taking on downside financial risk in the Medicare Shared Savings Program than ever before, with 37% in the program today participating in these arrangements. This is a notable increase in the number of downside-risk ACOs, according to an analysis from Avalere Health. By comparison, just 10% of ACOs assumed downside risk…

Number Of ACOs Taking Downside Risk Doubles Under ‘Pathways To Success’

January 10, 2020Garrett SchmittNo CommentsACOs, Downside Risk, MSSP, Pathways to Success, Risk, Seema Verma

In December of 2018, the Trump Administration overhauled the largest value-based payment program in fee-for-service Medicare—the Medicare Shared Savings Program (“Shared Savings Program” for short) for “Accountable Care Organizations” or ACOs. ACOs are groups of health care providers that agree to be held accountable for the quality, cost, and experience of care for a population…

The Case For Downside Risk (Or Not)

October 16, 2018Garrett SchmittNo CommentsAPM, APMs, Downside Risk, Pathways to Success, Risk

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…

‘A’ is for Accountable

August 21, 2018Garrett SchmittNo CommentsDownside Risk, Risk

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…