Alternative Payment Models

CMS Delays Radiation Oncology Model With No New Start Date

by Jacqueline LaPointe

The Radiation Oncology Model has been delayed indefinitely under a final rule released by CMS on Thursday. The alternative payment and care delivery model for cancer care aims to improve quality of...

Average Dialysis Facility Could Face Steep Penalty Under ETC Model

by Jacqueline LaPointe

Dialysis facilities required to participate in Medicare’s End-Stage Renal Disease Treatment Choices (ETC) model had a lower prevalence of transplantation waitlisting, living donor...

Risk-Based Alternative Payment Models Aid Chronic Disease Management

by Jacqueline LaPointe

Alternative payment models that put financial risk on healthcare providers improved care quality for patients with diabetes more so than fee-for-service and incentive payment programs, according to a...

CMS Analysis Reveals Implicit Bias in Healthcare, Value-Based Payment

by Jacqueline LaPointe

An internal analysis of three CMS Innovation Center models revealed instances of implicit bias in healthcare, which disproportionately impacted people of color and low-income individuals. CMS...

HHS Unveils New Alternative Payment Model for Cancer Care

by Jacqueline LaPointe

The Biden Administration recently announced a new alternative payment model from the CMS Innovation Center that will focus on improving cancer care quality and total cost of care around treating the...

AHA Recommends Changes to Radiation Oncology Model Following Delay

by Victoria Bailey

The American Hospital Association (AHA) has recommended changes to the CMS Radiation Oncology (RO) Model following the agency’s decision to delay the model’s start date. In a letter to CMS...

Advanced Bundled Payment Model Reduced Medicare Episode Payments

by Victoria Bailey

The CMS Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model reduced Medicare fee-for-service episode payments for both surgical and medical episodes, according to a new report for CMS...

Shared Savings in Value-Based Payment Models Produce More Incentives

by Victoria Bailey

Value-based payment models that shared five-year expected savings offered stronger incentives for clinicians to implement preventive interventions for postpartum depression compared to models that...

Global Hospital Budget Models May Help Curb Rising Hospital Prices

by Victoria Bailey

Global hospital budget models with a volume adjustment system could help limit hospital spending growth for commercial payers and patients, according to an issue brief from the Commonwealth...

Value-Based Payment Models Associated with Lower Acute Care Use

by Victoria Bailey

Medicare Advantage beneficiaries whose primary care organization participated in a value-based payment model saw lower rates of hospitalizations, observation stays, and emergency department visits,...

Collective Reform Program Participation Did Not Improve Health Outcomes

by Victoria Bailey

Collective participation in delivery system and payment reform programs, including accountable care organizations (ACOs), was not generally associated with improved health services outcomes in primary...

NAACOS, APG Urge HHS to Adjust Direct Contracting Model, Not Cancel

by Victoria Bailey

More than 200 healthcare organizations, including America’s Physician Groups (APG) and the National Association of ACOs (NAACOS), have urged the Department of Health and Human Services (HHS) to...

Signify Health to Acquire Caravan Health, Further Value-Based Care

by Victoria Bailey

Value-based care platform Signify Health has signed an agreement to acquire Caravan Health and aims to increase participation in value-based payment models and improve patient outcomes. The merger...

NAACOS, AMA Urge Congress to Boost Value-Based Care, APM Incentives

by Victoria Bailey

A group of eight healthcare organizations, including the American Medical Association (AMA) and National Association of ACOs (NAACOS), have asked Congress to increase their efforts in promoting...

More Beneficiaries, But Fewer ACOs for Medicare Shared Savings Program

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Medicare Shared Savings Program will care for more beneficiaries in 2022, making it the largest alternative payment model in Medicare despite lackluster ACO...

Over 50 Lawmakers Urge Administration to End Direct Contracting

by Sarai Rodriguez

More than 50 lawmakers led by US Representative Pramila Jayapa urged the Biden administration to discontinue the Medicare Direct Contracting (DC) program and transition Medicare...

The State of Value-Based Reimbursement, Financial Risk in Healthcare

by Jacqueline LaPointe

Most healthcare payments made in 2020 were tied in some way to value or quality of care, according to the latest data from the Health Care Payment Learning & Action Network (LAN). The LAN’s latest APM Measurement report showed...

Why Rural Providers Aren’t Transitioning to Alternative Payment Models

by Jacqueline LaPointe

A smaller percentage of providers in rural or health professional shortage areas eligible to participate in Advanced Alternative Payment Models (APMs) did partake in the Quality Payment Program track compared to providers not located in...

CMS Axes Primary Care First Model’s Seriously Ill Population Component

by Jacqueline LaPointe

CMS has notified providers via email that it will not move forward with the Seriously Ill Population (SIP) Component of the Primary Care First Model. The Model started in 2021 but the Biden...

How Providence Is Overcoming a Top Value-Based Care Challenge

by Jacqueline LaPointe

Providence St. Joseph Health has been at the forefront of delivering high-quality, affordable care to patients. Value-based care is a vital pillar of the health system’s strategic plan for transforming care to improve outcomes and...