Risk Management

AMA, NAACOS, AHIP share how to succeed in value-based care arrangements

April 15, 2024 - The American Medical Association (AMA), the National Association of Accountable Care Organizations (NAACOS), and AHIP have released a playbook on value-based care best practices, highlighting the importance of patient attribution, financial benchmarks, risk adjustment, and more. The organizations previously released data-sharing best practices and...

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Despite Value-Based Care Growth, Room for Improvement Remains

by Victoria Bailey

Healthcare organizations are becoming more familiar with value-based care, but opportunities remain to improve and expand upon the care delivery model, according to a survey conducted by Sage Growth...

Value-Based Reimbursement Grows as Providers Take on More Risk

by Jacqueline LaPointe

Over half of healthcare payments last year were made through value-based reimbursement models, with most of those payments tied to some degree of financial risk, according to the latest data from the Health Care Payment & Learning...

NAACOS: Medicare Shared Savings Program Needs Full-Risk Option

by Victoria Bailey

A full-risk option in the Medicare Shared Savings Program (MSSP) would offer accountable care organizations (ACOs) additional flexibility and more capitation options, according to the National...

Community-Level Social Risk Adjustment Did Not Address Payment Disparities

by Victoria Bailey

Despite the notion that social risk adjustment may improve health equity in value-based payment models, incorporating community-level social risk factors into Medicare risk adjustment did little to...

Should Population-Based Payments Account for Social Risk Factors?

by Jacqueline LaPointe

Efforts to make the healthcare system more efficient and equitable by adjusting population-based payments for social risk factors may be missing the mark, suggests a new study from Harvard and Yale....

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...

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...

Shared Financial Risk Lowered Healthcare Costs for CA Residents

by Victoria Bailey

California residents and health systems saw lower healthcare costs and higher clinical quality when providers and payers shared financial risk, according to data from the Integrated Healthcare...

Challenges, Trends Among ACO Home-Based Care Initiatives

by Victoria Bailey

Home-based care initiatives were common among accountable care organizations (ACOs), but ACO leaders cited the lack of return on investment as a barrier to expanding these services, according to a...

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,...

Medical Liability Insurance Premiums Continued to Increase in 2021

by Victoria Bailey

Nearly 30 percent of medical liability insurance premiums increased in 2021, continuing the trend of rising premiums that medical practices have been seeing since 2019, a report from the American...

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...

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...

Health Systems Set Sights on Risk-Based Payment in Medicare Advantage

by Jacqueline LaPointe

Health systems are planning to advance their risk-based payment strategies by taking on more upside or downside risk, professional capitation, or global capitation in Medicare Advantage lines of...

Key Characteristics for Successful Downside Risk Contracting

by Erin McNemar, MPA

Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working...

Risk-Based Revenue Stalls Despite Challenges with Fee-For-Service

by Jacqueline LaPointe

Most hospitals suffered heavy financial losses during the COVID-19 pandemic as a direct result of the fee-for-service payment system, yet progress toward a more stable, risk-based revenue structure...

AMGA to CMS: Rethink ACO Financial Risk Advancement in MSSP

by Victoria Bailey

The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a...

No Extension for Next Generation ACO Model After This Year

by Jacqueline LaPointe

The Next Generation Accountable Care Organization (ACO) Model will come to an end at the end of this year as planned despite several calls for an extension, according to an email to model...

Industry Groups Seek Next Gen Extension, Full-Risk ACO Options

by Jacqueline LaPointe

A group of leading healthcare industry groups are calling on HHS to provide more full-risk accountable care organization (ACO) model options, including an extension of the popular Next Generation ACO...

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