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

Accountable Care Organizations

CMS Welcomes 58 Next Generation ACO Model Participants in 2018

January 23, 2018 - 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 of 2018 Next Generation ACOs includes 14 new and 44 renewing organizations. The highest-risk Medicare ACO program has seen significant growth since the...


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

by Jacqueline Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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)...

Collaboration Key to Independent Physicians in Value-Based Care

by Kyle Murphy, PhD

At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists but...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings

by Jacqueline Belliveau

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 Belliveau

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...

AMGA to Reps: Pass CHRONIC Care Act to Aid ACOs, Team-Based Care

by Jacqueline Belliveau

AMGA recently pushed House Representatives to pass the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which would particularly support accountable care organizations (ACO) implementing chronic...

61% of Next Generation ACOs Earned Shared Savings in 2016

by Jacqueline Belliveau

The majority of Next Generation Accountable Care Organizations (ACOs) earned shared savings in the first year of the model, recent data from CMS revealed. Eleven of 18 total Next Generation ACOs will receive a shared savings payment from CMS,...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

by Jacqueline Belliveau

Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of 240 ACOs...

MSSP ACOs Decreased Spending by $1B, Improved Care Quality

by Jacqueline Belliveau

Accountable care organizations (ACOs) participating in the first three years of the Medicare Shared Savings Program (MSSP) reduced Medicare spending, with a net reduction of almost $1 billion, according to a new OIG report. The analysis of 428...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline Belliveau

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and patient...

Accountable Care Organization Saves $4.8M With Nutrition Aid

by Jacqueline Belliveau

A case study in American Health & Drug Benefits showed that Advocate Health Care, an accountable care organization in the Chicago area, reduced healthcare costs by $3,800 per patient, or $4.8 million in total, by implementing a nutrition...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline Belliveau

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient populations. In...

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