Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Accountable Care Organization

Key Issues Impacting Two-Sided Risk Accountable Care Organizations

June 20, 2018 - Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives, benchmarks, and other issues to ensure two-sided risk ACOs continue to generate savings, the Medicare Payment Advisory Commission (MedPAC) recently reported. “Medicare...


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Medicare Spending Greater on Patients in Downside Risk MSSP ACOs

by Jacqueline LaPointe

Moving accountable care organizations (ACOs) to Medicare Shared Savings Program (MSSP) tracks with downside financial risk may not help the accountable care initiative generate savings, according to a new analysis from the Center for Healthcare...

House Reps Want to Extend MSSP Track 1 ACO Participation

by Jacqueline LaPointe

Seven House Representatives are calling on CMS to allow successful accountable care organizations (ACOs) in the Medicare Shared Savings Program’s (MSSP) Track 1 to continue in the upside-only financial risk track for a third agreement period....

71% of MSSP ACOs Likely to Quit Rather Than Assume Downside Risk

by Jacqueline LaPointe

The Medicare Shared Savings Program (MSSP) is requiring the 82 accountable care organizations (ACOs) that started in upside-only financial risk tracks in 2012 or 2013 to take on downside financial risk by 2019. However, the majority of these...

Emory Healthcare, Walmart Team Up for an ACO, Bundled Payments

by Jacqueline LaPointe

Atlanta-based Emory Healthcare recently announced the creation of an accountable care organization (ACO) with retail giant Walmart, known as the Accountable Care Plan. Walmart employees at 55 Walmart, Sam’s Club, and Walmart Distribution...

A Holistic View of the Patient Enables Risk-Based ACO Success

by Jacqueline LaPointe

Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in the Medicare...

Orgs Push for MSSP Track 1 Extension for Non-Risk-Bearing ACOs

by Jacqueline LaPointe

Six healthcare industry groups are urging CMS to extend participation in the Medicare Shared Savings Program (MSSP) Track 1 beyond two agreement periods to allow accountable care organizations (ACOs) more time to assume downside financial risk....

MSSP ACOs Save More By Spending Less on Inpatient, Post-Acute Care

by Jacqueline LaPointe

Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have shifted their spending to physician services and away from inpatient and skilled nursing facility care, according to a recent study in the American Journal of Accountable...

CMS Welcomes 58 Next Generation ACO Model Participants in 2018

by Jacqueline LaPointe

In 2018, the Next Generation ACO model will have a total of 58 participating accountable care organizations (ACOs), up from 45 organizations the previous year, CMS recently announced on the program’s Innovation Center webpage. The class...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline LaPointe

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care organizations...

Risk-Averse MSSP ACOs Missed $966M By Not Assuming Downside Risk

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the non-risk bearing track of the Medicare Shared Savings Program (MSSP) could have boosted their bottom lines by an additional $966 million in net payments in 2016 if they had assumed downside risk in...

MSSP Accountable Care Organizations Moving to Risk in 2018

by Jacqueline LaPointe

According to a new fact sheet from CMS, the Medicare Shared Savings Program (MSSP) will see some fresh faces in 2018, as well as more accountable care organizations (ACOs) entering downside financial risk tracks. The federal agency reported that...

Vermont ACO Receives $620M to Lead Healthcare Reform Efforts

by Jacqueline LaPointe

Vermont’s healthcare reform group, Green Mountain Care Board, recently approved a budget of $620 million for OneCare Vermont, an accountable care organization (ACO) working with Medicare, Medicaid, and private payers, local news sources...

New Reporting, Shared Losses Rules for MSSP ACOs in Disaster Areas

by Jacqueline LaPointe

In a new interim final rule, CMS modified quality reporting and shared losses policies for Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) affected by recent natural disasters, such as this year’s major hurricanes...

Stakeholders Back Standard ACO Measures for Commercial Orgs in CA

by Jacqueline LaPointe

The Integrated Healthcare Association (IHA) and Pacific Business Group on Health (PBGH) recently embarked on a joint mission to standardize accountable care organization (ACO) measures for quality and cost performance and benchmarking for commercial...

ACO, Bundled Payments Alignment Key to Success for Both Models

by Jacqueline LaPointe

CMS should align accountable care organizations (ACOs) and bundled payments by creating a blended accountability structure that allows organizations to participate in both alternative payment models without financial conflicts, industry experts...

High-Risk Patient Management Did Not Drive Early ACO Cost Savings

by Jacqueline LaPointe

Care coordination and care management strategies focused on high-risk and chronically ill patients did not drive early cost savings among accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP), a recent Health Affairs...

High-Value Culture, Population Health Programs Key to ACO Success

by Jacqueline LaPointe

Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations (ACOs)...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings

by Jacqueline LaPointe

Medicare accountable care organizations (ACOs) found overwhelming success with care quality improvements in 2016, but the organizations were still working on reducing costs, according to a recent analysis published in the Health Affairs blog....

Accountable Care Organizations Cut Medicare Spending by $836M

by Jacqueline LaPointe

Accountable care organizations (ACOs) decreased Medicare spending by $836 million in 2016, new data from CMS revealed. As a result, the organizations from four Medicare ACO programs returned about $70.6 million in healthcare savings to the Medicare...

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