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New Opportunities for Provider Collaboration Stark and Anti-Kickback Statute Standards for Value-Based Care, Part 2: Creating a Value-Based Enterprise

May 6, 2021Garrett SchmittNo Commentsprovider collaboration, vbc

The first step in qualifying to meet the requirements of a value-based Stark exception or a valuebased Anti-Kickback Statute safe harbor is that the parties establish a “value-based enterprise.” The concept of a value-based enterprise is very definitionally driven, so before attempting to create a value-based enterprise it is imperative to fully understand the regulatory…

ABCs of VBC: CMS Value-Based Initiatives – A Current Review and Future Perspective

May 3, 2021Garrett SchmittNo CommentsACOs, Advanced Alternative Payment Models, Answers Media Network, Azara Healthcare, BPCI, CMS, David Smith, direct contracting, Medicaid, Medicare, MIPS, Third Horizon Strategies, vbc

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…

New Opportunities for Provider Collaboration Stark and Anti-Kickback Statute Standards for Value-Based Care, Introduction

May 3, 2021Garrett SchmittNo Commentsprovider collaboration, vbc

In November of 2020 the Centers for Medicare & Medicaid Services (“CMS”) finalized value- based exceptions under the Stark Law and the Office of Inspector General (“OIG”) finalized value- based safe harbors under the Anti-Kickback Statute, in an effort to accommodate and facilitate the evolution of value-based care arrangements among health care providers. “Value-based care”…

New ACO Playbook: Can Coordination Of Care Save Enough Money To Save ACOs?

April 29, 2021Garrett SchmittNo CommentsACOs, care coordination, care plans, care teams, CMS, CMS Innovation Center, coordination of care, data organization, direct contracting, Medicare, organization of care, Primary Care First, savings, Shared Savings, vbc

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…

Focus on Quality in Value-Based Care Could Impact Hospice M&A

April 28, 2021Garrett SchmittNo CommentsCMS, hospice, Medicare Advantage, private equity investors, vbc

A robust hospice mergers and acquisitions market is showing no signs of slumping as interest among strategic buyers and private equity investors ramps up. A provider’s performance within evolving value-based payment models may become a factor that potential buyers consider when eyeing a hospice acquisition, particularly as it pertains to their quality and outcomes data….

In Providers’ Words: What’s Working and What’s Not in Value-Based Care Today

April 27, 2021Garrett SchmittNo CommentsACOs, APMs, benchmarks, care coordination, CIN, CMS, congress, evidence-based care, FFS, Integrated Health Partners, legislature, MACRA, MIPS, Next Generation ACOs, Payers, SNFs, specialist incentives, Telehealth, vbc

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…

How value-based care helped our independent practice survive 2020

April 26, 2021Garrett SchmittNo CommentsCollaboration, COVID-19, independent practice, quality care, Shared Savings, Specialists, Telehealth, vbc, virtual care

When the COVID-19 pandemic began to disrupt daily life in the U.S., many medical practices were left scrambling. Patient volumes plunged immediately, non-urgent care was postponed, and no one was sure exactly how long the shutdowns and mitigation precautions would last. By late April, 97% of practices reported a negative financial impact from the pandemic,…

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…

CMMI Chief Fowler: Value-Based Care at a Crossroads

April 20, 2021Garrett SchmittNo CommentsACOs, Biden, CMMI, CMS, Fowler, Geographic Direct Contracting, hospice, Medicare Advantage, Medicare Care Choices Model, MSSP, NAACOS, Primary Care First, Seriously Ill Population, vbc

The Center for Medicare & Medicaid Innovation (CMMI) remains committed to moving the health care system towards value-based care in the early years of the Biden Administration, though the center’s leadership is doing some soul-searching on how best to pursue its mission, according to CMMI’s new director Liz Fowler. Fowler made her first public remarks…

Social Determinants of Health: Technology, examples and healthcare trends in 2021

April 16, 2021Garrett SchmittNo CommentsCareMore Health System, Cityblock Health, COVID-19, digital health, EHRs, Fitbit, Google, Healthcare Natural Language API, Lyft, NEMT, SDOH, Social Determinants of Health Report, Uber, Unite Us, vbc

The coronavirus pandemic afflicted the US healthcare industry at a time when it was already experiencing rising rates of chronic disease, doctor burnout, and staff shortages—but it especially took a toll on some of the most vulnerable, at- risk communities across the country. Widening health disparities are leading healthcare payers and providers to broaden the…