Value-Based Care News

Payers, Providers Need Data to Talk Value-Based Care

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The definition of value is evolving, and so are the capabilities needed to support the transition to value-based care, industry experts recently shared at Xtelligent Healthcare Media’s...

ACOs, Population-Based APMs Most Effective at Lowering Costs

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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

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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

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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...

Most Facilities in Hospital Readmissions Reduction Program Penalized

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The majority of facilities participating in the Hospital Readmissions Reduction Program (HRRP) in fiscal year (FY) 2021 have been penalized for readmitting too many patients according to CMS...

CMS Releases Initial Quality Payment Program Results for 2019

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Eligible clinicians overwhelmingly participated in the Quality Payment Program despite facing challenges caused by the COVID-19 pandemic, according to preliminary data from CMS. CMS announced in a...

CMS Pushes Back Launch of Radiation Oncology Model

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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

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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...

Top 10 Accountable Care Organizations by Shared Savings in 2019

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Accountable care organizations (ACOs) in the Medicare Shared Savings Program collectively saved $2.6 billion in 2019, netting Medicare $1.19 billion, according to the latest program performance...

Private Payers Outpace Public Insurance in Value-Based Care Push

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Private payers are leading the charge away from fee-for-service reimbursement. These parties are more likely than public payers to participate in value-based reimbursement models, according to the...

Most ACOs Worried About Rising Advanced APM Thresholds Next Year

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A new survey confirms a growing concern among accountable care organizations (ACOs) – most ACOs are unlikely to meet rising participation thresholds for MACRA’s Advanced Alternative Payment...

CMS Finalizes Alternative Payment Models for Specialty Care

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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...

Multi-Payer Alignment Key to Advancing Value-Based Care in Medicaid

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In a new letter to Medicaid directors, CMS called for multi-payer alignment in value-based care arrangements run by the state healthcare programs. The Sept. 15th letter providers guidance to the...

Major Changes Coming to BPCI Advanced Clinical Episodes, Prices

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CMS is making major changes to Bundled Payments for Care Improvement (BPCI) Advanced next year to stop the model from generating financial losses of close to $2 billion over the model’s ten...

Medicare Shared Savings Program Saved a Record $1.19B in 2019

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Medicare Shared Savings Program (MSSP) generated $1.19 billion in total net savings to Medicare in 2019, representing the third consecutive year for net program savings and the largest annual savings...

Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

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Clinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received...

Coronavirus Pandemic Impacts Value-Based Contracts

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The coronavirus pandemic highlighted the importance of value-based contracts and reimbursement and will continue to push the industry towards these models of care, according to healthcare stakeholder...

PCPs Paid Under Global Capitation Deliver Higher Quality Care

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Global capitation payments provide strong incentives for primary care physicians to achieve key quality metrics, including cancer screening and medication review, UnitedHealth Group concluded from new...

CMS Unveils New Value-Based Care, ACO Options for Rural Providers

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A new rural health model recently unveiled by CMS will offer rural providers and their communities new funding opportunities to bolster value-based care through capitated payments and accountable care...