Value-based Reimbursement

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,...

Stratifying Hospital Readmissions Reduction Program Improved Equity

by Victoria Bailey

Implementing stratification within the Medicare Hospital Readmissions Reduction Program (HRRP) helped improve health equity by decreasing penalty rates for safety-net hospitals, rural hospitals, and...

Organizations Urge CMS, HHS to Terminate New ACO REACH Model

by Victoria Bailey

More than 200 healthcare organizations, including Physicians for a National Health Program (PNHP) and the American Medical Student Association, have urged CMS and HHS to terminate the ACO REACH model,...

CMS Replaces Direct Contracting Model with New ACO REACH Model

by Victoria Bailey

CMS has overhauled the Global and Professional Direct Contracting model and announced the ACO Realizing Equity, Access, and Community Health (REACH) model. The redesigned accountable care organization...

Former Obama Appointees Urge HHS, CMS to Continue Direct Contracting

by Victoria Bailey

A group of former appointees under the Obama administration are urging federal officials to preserve the Global and Professional Direct Contracting model, stating that the model helps accountable care...

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...

764 Hospitals Face Value-Based Penalties Under HAC Reduction Program

by Victoria Bailey

More than 700 hospitals will face value-based penalties in fiscal year 2022 after underperforming in Medicare’s Hospital-Acquired Condition (HAC) Reduction Program, according to an Advisory Board...

Physician Compensation Still Hinges on Volume at System-Owned Practices

by Jacqueline LaPointe

Despite a decades-long push toward value-based payment, physician compensation arrangements at health system-owned practices still primarily revolves around the volume of services delivered, according...

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...

Providers Dodged Major Medicare Payment Cuts But More Work To Be Done

by Jacqueline LaPointe

Healthcare providers have evaded a nearly 10 percent reduction to their Medicare payments in 2022 thanks to swift Congressional action. However, more work still needs to be done to support physicians and hospitals as they navigate a...

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...

APM Adoption Slows as Price Transparency Capabilities Heat Up

by Jacqueline LaPointe

Revenue cycle management and healthcare finance priorities shifted during the COVID-19 pandemic, with alternative payment model (APM) adoption taking a backseat to price transparency and other...

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...

Automatic MIPS Participation Exemption for Individual Eligible Clinicians

by Jacqueline LaPointe

CMS is exempting all individual eligible clinicians from Merit-Based Incentive Payment System (MIPS) participation in the 2021 performance year (PY). The eligible clinicians will receive an automatic...

Study: Consecutive Penalties for Preventable Hospital Readmissions

by Victoria Bailey

More than 1,200 hospitals have faced penalties for preventable hospital readmissions every year for the last 10 years since the launch of the Hospital Readmissions Reduction Program (HRRP), according...

62% of Consumers Unfamiliar with Value-Based Care, Study Finds

by Victoria Bailey

More than half of consumers are unfamiliar with value-based care, and for the ones who are aware of it, only a quarter can define the healthcare model correctly, a new study from nonprofit health plan...