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

Accountable Care Organizations

How Accountable Care Organizations Can Prepare for Downside Risk

March 14, 2019 - Accountable care organizations (ACOs) are part of the foundation of the healthcare industry’s transition to value-based care and purchasing. Since the passage of the Affordable Care Act (ACA), ACOs have realized clinical and financial improvements. Organizations in the Medicare’s largest ACO program average a quality performance score north of 90 percent, and CMS estimates...


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Large, Experienced ACOs Assume Downside Financial Risk Sooner

by Jacqueline LaPointe

Larger, more experienced accountable care organizations (ACOs) are more likely to assume downside financial risk, according to a recent analysis by Leavitt Partners. ACOs that took on downside financial risk after participating in an...

Humana Brings Value-Based Care to Independent Practices in 3 States

by Jacqueline LaPointe

Humana is helping bring value-based care to independent practices in Louisiana, Pennsylvania, and West Virginia. The Louisville, Kentucky-based payer announced a new value-based care arrangement with physicians in Aledade’s...

Post-Acute, At-Home Care Saves Next Gen ACO Atrius Health $19.9M

by Jacqueline LaPointe

“You can't emphasize enough the right setting and the right care,” stressed Peggy Chou, MD, the Senior Medical Director of Performance Excellence of Atrius Health in Massachusetts. Atrius Health is a non-profit system of...

More Groups Want to Extend Medicare Shared Savings Program Deadline

by Jacqueline LaPointe

Eleven healthcare industry groups are supporting the National Association of ACOs’ (NAACOS) call for CMS to extend the Feb. 19 application deadline for the Medicare Shared Savings Program (MSSP). CMS announced earlier this month...

67% of MSSP ACOs May Be High-Revenue Under Pathways to Success

by Jacqueline LaPointe

Over two-thirds of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) would qualify as high-revenue organizations under the new Pathways to Success initiative, a recent Leavitt Partners analysis...

CMS Announces Feb 19 Deadline for Pathways to Success Applications

by Jacqueline LaPointe

Accountable care organizations (ACOs) can start their Pathways to Success applications to participate in the initiative replacing the Medicare Shared Savings Program (MSSP) in the summer of 2019. The organizations will have between Jan. 22...

ACO Financial Risk Rules for Pathways to Success Raise Concerns

by Jacqueline LaPointe

Leading healthcare industry groups are concerned that the overhaul of the Medicare Shared Savings Program (MSSP) will impede the transition to value-based care. On December 21, 2018, CMS finalized changes to the largest Medicare...

Next Generation Accountable Care Organizations Save $164M

by Jacqueline LaPointe

Accountable care organizations (ACOs) assuming the highest levels of financial risk in Medicare saved $164 million during their second performance year, CMS recently reported. Medicare ACOs bring together groups of physicians, hospitals,...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs

by Jacqueline LaPointe

CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the largest Medicare ACO program, boasting...

36% of ACOs Consider Quitting MSSP Under New Proposed Rules

by Jacqueline LaPointe

Over one-third of accountable care organizations (36 percent) said they are unlikely to continue with the Medicare Shared Savings Program (MSSP) if the proposed overhaul is finalized, a recent survey showed. Only 48 percent of ACO leaders...

Medical Spending, Utilization the Same for Cancer Patients in ACOs

by Jacqueline LaPointe

Cancer patients treated by providers in a Medicare accountable care organization (ACO) did not see lower medical spending or healthcare utilization compared to similar patients treated at non-ACO practices, a new study in the Journal of...

61% of Doctors Say Value-Based Care Will Damage Their Practice

by Jacqueline LaPointe

Physicians are still on the fence about the impact value-based care will have on their business and patient care, a recent survey showed. Forty-nine percent of over 3,400 physicians recently surveyed by the nation’s largest...

AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP

by Jacqueline LaPointe

The American Medical Association (AMA), Medical Group Management Association (MGMA), and Health Care Transformation Task Force (HCTTF) are among nine industry groups calling on CMS to reconsider proposed changes to the Medicare Shared...

Time Helps Accountable Care Organizations Realize Savings in MSSP

by Jacqueline LaPointe

Experience is a key factor to realizing greater cost savings in the Medicare Shared Savings Program (MSSP), a new Avalere analysis found. Accountable care organizations (ACOs) in the MSSP for four or more years generated nearly all of the...

Policymakers Concerned with ACO Shared Savings Under Updated MSSP

by Jacqueline LaPointe

The House Committee on Ways and Means recently voiced concerns that proposed changes to the shared savings arrangements under the Medicare Shared Savings Program (MSSP) overhaul would harm accountable care organizations (ACOs). In a...

MSSP ACOs Saved $1.84B, Nearly Double CMS Estimate, Study Finds

by Jacqueline LaPointe

CMS estimates that accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved $954 million from 2013 to 2015. However, a new Dobson DaVanzo & Associates analysis, commissioned by the National Association...

How Next Generation ACOs Built a Foundation for Success

by Jacqueline LaPointe

Employing additional administrative staff, prioritizing care management, and building data analytics capacity were key strategies accountable care organizations (ACOs) implemented to participate in the Next Generation model, CMS recently...

More MSSP ACOs Saved Money, Earned Shared Savings in 2017

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) generated about $314 million in net Medicare savings in 2017, according to new MSSP performance data from CMS. In 2017, 472 ACOs in the largest Medicare...

CMS to Offer More Flexibility to Risk-Bearing ACOs, Verma Says

by Jacqueline LaPointe

Federal regulations and rules are commonly cited as barriers to implementing value-based reimbursement models. The rules can prevent care coordination and appropriate transitions of care, which negatively impact an accountable care...

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