Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Accountable Care Organizations

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

January 11, 2017 - In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced the MSSP Track 1+ model in December 2016 as a new accountable care organization (ACO) model with a limited downside financial risk. Based on stakeholder...


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CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

by Jacqueline Belliveau

In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced...

NAACOS Reveals 2017 Accountable Care Organization Priorities

by Jacqueline Belliveau

As part of its 2017 advocacy agenda, the National Association of Accountable Care Organizations (NAACOS) released policy recommendations for ACO improvement. The recommendations included Medicare Shared Savings Program (MSSP) changes, one-sided...

ACO Incentives, Coordination Improve Complex Pediatric Care

by Jacqueline Belliveau

Children with medical complexities, or children who require the highest level of service and support, are one of the most expensive pediatric patient populations. But provider collaboration and financial incentives through an accountable care...

What is the Medicare Shared Savings Program Track 1+ Model?

by Jacqueline Belliveau

As the Quality Payment Program links more Medicare payments to value-based reimbursement, a new Medicare Shared Savings Program (MSSP) track will allow eligible clinicians to qualify for additional incentive payments in the program’s Advanced...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by Jacqueline Belliveau

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

61% of ACO Contracts Only Include Upside Financial Risk

by Jacqueline Belliveau

A recent Leavitt Partners study showed that 61 percent of accountable care organization (ACO) contracts are upside risk-only, indicating that ACOs may be risk-adverse or are still in the experimental stage with financial risk. Even though ACOs...

Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

by Jacqueline Belliveau

Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving...

CMS Grants $1.8B to MA Value-Based ACO Implementation Program

by Jacqueline Belliveau

The MassHealth program in Massachusetts will received about $1.8 billion over the next five years to implement value-based reimbursement structures in the statewide accountable care organization (ACO) component of the program, announced CMS....

CMS Launches VT All-Payer Accountable Care Organization Model

by Jacqueline Belliveau

Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

Provider Engagement Key to Accountable Care Organization Success

by Jacqueline Belliveau

Accountable care organizations (ACOs) leaders may need to boost healthcare provider engagement to foster value-based care success, a recent study in the American Journal of Accountable Care indicates. In a case study at the Johns Hopkins Medicine...

House Reps Introduce Medicare ACO Improvement Legislation

by Jacqueline Belliveau

House representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced a bill last week that would change the rules for Medicare accountable care organizations (ACOs). The ACO Improvement Act of 2016 contains reforms for Medicare Shared Savings...

Challenges, Successes of First-Year Shared Savings ACOs

by Jacqueline Belliveau

Participants in the Medicare Shared Savings Program (MSSP) already familiar with physician practice transformation were more likely to earn shared savings payments, which should lead the Centers for Medicare & Medicaid Services to focus on...

How Pioneer ACOs Earn Shared Savings, Improve Care Quality

by Jacqueline Belliveau

Massachusetts-based Atrius Health successfully managed several care quality improvements over the previous year and earned both the recognition of CMS and a portion of shared savings as a participant in the Pioneer ACO Model program. In August,...

Next Generation Model Methodology May Boost MSSP ACO Success

by Jacqueline Belliveau

CMS should use a modified Next Generation model benchmark methodology to calculate healthcare cost thresholds to ensure all accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have an equal opportunity to earn...

CMS: Medicare Accountable Care Organizations Saved Over $466M

by Jacqueline Belliveau

Medicare accountable care organizations (ACOs) saved more than $466 million in 2015, with 125 ACOs qualifying for shared savings payments under the value-based care model, CMS reported in an announcement earlier this week. “The coordinated,...

How CMS Would Reimburse ACOs for Value-Based Care under MIPS

by Jacqueline Belliveau

With a final rule on implementing MACRA coming in the next couple of months, some accountable care organizations (ACOs) have started to analyze new value-based reimbursement structures under the proposed rule. While only a couple of Medicare...

Non-ACO Hospitals Outperform ACOs in Value-Based Care Programs

by Jacqueline Belliveau

To usher in the age of value-based care, CMS has implemented several value-based care programs and introduced various alternative payment models, such as accountable care organizations (ACO). These programs all have a common goal: raise care...

Medicare ACOs Reduce Healthcare Spending On Complex Patients

by Jacqueline Belliveau

While one of the primary goals of joining an accountable care organization (ACO) is to coordinate care in effort to reduce healthcare spending, many Medicare ACO participants have seen early benefits from the alternative payment model. According...

The Future of Accountable Care Organizations Involves Risk

by Jacqueline Belliveau

As many healthcare providers know, participating in a value-based care program, such as an accountable care organization, is about more than just tying payment to quality.  It involves shouldering financial risk as a way to motivate clinicians...

Characteristics of Successful Accountable Care Organizations

by Jacqueline Belliveau

As the number of accountable care organizations (ACO) continues to grow, many healthcare providers are all too familiar with the alternative payment model’s overarching goals of improving care quality, advancing population health, and reducing...

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