Alternative Payment Models

CMS Stops Accepting New Direct Contracting Applications

by Jacqueline LaPointe

CMS has announced that it will not be soliciting any more applications for the Global and Professional Direct Contracting Models slated to launch on January 1, 2022. Organizations that had already...

CMS Delays CHART Model’s ACO Transformation Track

by Jacqueline LaPointe

CMS has pushed back the application cycle by a year for a new rural-focused accountable care organization (ACO) model. In an email sent yesterday, CMS said it has delayed the request for applications...

CMS Starts Primary Care First Value-Based Payment Model Second Wave

by Hannah Nelson

The Centers for Medicare and Medicaid Services (CMS) has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase...

CMS Announces 184 Participants For ET3 Model, New Funding

by Jacqueline LaPointe

CMS has shared the final list of 184 public and private ambulance providers and suppliers selected to participate in the agency’s Emergency Triage, Treat, and Transport (ET3) Model, an...

Risk Stratification Of Bundled Payment Models Requires Clinical Data

by Hannah Nelson

Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis. The OCM is a...

Biden Administration Pauses Key Value-Based Reimbursement Models

by Jacqueline LaPointe

The Biden administration has paused several prominent value-based reimbursement models run by the CMS Innovation Center (CMMI) to review model details, according to several updates provided on model...

Preparing Physician Practices for Direct Contracting, Risk Models

by Jacqueline LaPointe

Physicians want three things, according to Anthony Valdés, President of Collaborative Health Systems, and those are to deliver great clinical outcomes, get paid fairly for that...

Addressing Social Determinants Lowered ED Utilization in Medicare

by Jacqueline LaPointe

A CMS-run care delivery model focused on addressing social determinants of health has effectively identified higher cost and utilization patients while reducing potentially unnecessary emergency...

ACO Participation Hits New Low as Biden Administration Takes Over

by Jacqueline LaPointe

Accountable care organization (ACO) participation in the Medicare Shared Savings Program has hit a new low in 2021, according to new data from CMS. The data dropped by CMS this week showed that 477...

Next Generation ACOs Saved Medicare $558M in 2019

by Jacqueline LaPointe

Accountable care organizations (ACOs) taking on the greatest financial risk in Medicare through the Next Generation ACO Model saved the public payer over $558 million in 2019, according to partial data...

Fee-For-Service Payments Still an Issue in VT All-Payer ACO Model

by Jacqueline LaPointe

Reimbursing accountable care organizations (ACOs) for value in a primarily fee-for-service payment environment is creating implementation challenges for Vermont’s innovative All-Payer ACO Model,...

ACOs Fear Direct Contracting Options Stray Too Far From Providers

by Jacqueline LaPointe

Value-based providers, like accountable care organizations (ACOs), may be at a disadvantage under new direct contracting options in Medicare that allow for a broad range of healthcare organizations to...

CMS Announces A New Value-Based Direct Contracting Model

by Jacqueline LaPointe

A new direct contracting model from CMS will test whether a geographic-based approach to value-based care can improve quality of care while reducing costs for Medicaid beneficiaries in a specific...

ACOs, Population-Based APMs Most Effective at Lowering Costs

by Jacqueline LaPointe

If CMS aims to lower healthcare costs and improve quality, then the agency should use more population-based alternative payment models, like accountable care organizations (ACOs), according to a new...

Key Considerations for Providers Thinking of Capitation Payments

by Jacqueline LaPointe

More providers are thinking of switching to capitation payments in light of the COVID-19 pandemic. However, the decision should not be taken lightly; provider organizations need to consider the major...

51 Organizations Join New Direct Contracting Opportunity from CMS

by Jacqueline LaPointe

CMS recently announced that 51 organizations will take part in a new directing contracting opportunity that will test what the agency calls the “next evolution of risk-sharing...

CMS Pushes Back Launch of Radiation Oncology Model

by Jacqueline LaPointe

CMS recently announced via email that it intends to delay the start of the Radiation Oncology Model after receiving feedback from stakeholders. “CMS has received feedback from a number of...

Designing Alternative Payment Models for Health System Resiliency

by Jacqueline LaPointe

Alternative payment models that use population-based payments to incent providers to deliver coordinated, high quality, person-centered care are key to building healthcare system resiliency after a...

How Top Accountable Care Organizations Save Year After Year

by Jacqueline LaPointe

Accountable care organizations had a record year, according to the latest performance data for the Medicare Shared Savings Program. CMS recently announced that organizations participating in the program – which are otherwise known...

CMS Finalizes Alternative Payment Models for Specialty Care

by Jacqueline LaPointe

CMS is transitioning more specialty care to value-based reimbursement with two new alternative payment models for end-stage renal disease and cancer care. A final rule released late last week unveiled...