Alternative Payment Models

CMS Seeks Extension for Comprehensive Care for Joint Replacement

by Jacqueline LaPointe

The Comprehensive Care for Joint Replacement (CJR) Model is slated to sunset by the end of the year, but a recently proposed rule from CMS would extend the bundled payment program for another three...

Patient-Driven Payment Model Reimbursement Exceeds CMS Prediction

by Emily Sokol, MPH

Initial analysis of the Patient-Driven Payment Model (PDPM) shows success in the model’s rollout, exceeding the Centers for Medicare and Medicaid’s (CMS’s) predictions. The model,...

Policymakers, Industry Leaders Call for Innovation Center Changes

by Jacqueline LaPointe

The CMS Innovation Center – otherwise known as CMMI – has been the federal government’s key instrument for healthcare payment and care delivery reform. But lately, policymakers and...

The Role of the Accountable Care Organization in Value-Based Care

by Emily Sokol, MPH

Accountable care organizations (ACOs) were created to push the industry away from fee-for-service towards value-based care. Through care coordination and a shared savings payment model, ACOs strive to...

ACOs Enrolled in MSSP Assume Downside Risk as the Program Matures

by Samantha McGrail

More accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) have assumed downside risk as the program progresses, according to a new Avalere analysis. Most...

What the Latest ACO Numbers Mean for the Future of the MSSP

by Jacqueline LaPointe

Last week, CMS Administrator Seema Verma reported that CMS approved the applications for 53 new accountable care organizations (ACOs) to join the Medicare Shared Savings Program (MSSP) starting on Jan....

Entering the Next Phase of Value-Based Care, Payment Reform

by Jacqueline LaPointe

“What healthcare providers really want is to do is the right thing for their patients. They just need sustainable financial support for doing that,” health economist Mark McClellan, MD, PhD, said at the start of an interview...

CMMI Alternative Payment Models Won’t Save As Much as CBO Projects

by Samantha McGrail

Medicare will save approximately $18 billion from alternative payment models run by CMS’ Innovation Center (CMMI) between 2017 and 2026, a $16 billion difference compared to predictions from the...

Next Generation ACOs Saved Medicare Over $184M in 2018

by Jacqueline LaPointe

Next Generation accountable care organizations (ACOs) reduced spending by about 1.11 percent in 2018, returning more than $184 million to the Medicare Trust Funds, according to new program results from...

Value-Based Care Consulting Firms Receive Top Marks from Providers

by Jacqueline LaPointe

Value-based consulting firms are worth the money, according to provider organizations participating in a recent KLAS survey. In the report Value-Based Consulting 2019, KLAS analyzed nine consulting...

Former Anthem Exec to Lead CMMI, Value-Based Care Efforts at HHS

by Jacqueline LaPointe

The Trump administration announced on Monday that it has picked Brad Smith to serve as director of the CMS Innovation Center (CMMI), where he will oversee the development and testing of value-based...

Medicare Oncology Care Model Needs Refinement to Boost Reach

by Samantha McGrail

Medicare’s Oncology Care Model (OCM) is a promising start to payment reform for oncology care but the model needs several vital changes to improve the model’s effectiveness and reach across...

NAACOS Establishes Direct Contracting Taskforce

by Samantha McGrail

The National Association of Accountable Care Organizations (NAACOS) recently announced the formation of the Direct Contracting Taskforce, which offered tools for participation in the latest accountable...

7 MI Providers Take on Shared Risk Payment Model with Blue Cross

by Samantha McGrail

Seven healthcare organizations in Michigan recently signed on to participate in a new shared-risk payment model with Blue Cross Blue Shield of Michigan that will hold the providers accountable for...

AHA: Payment Reform Needed to Improve Access to Rural Healthcare

by Samantha McGrail

The low-volume payment adjustment, new rural hospital designations, alternative payment model demonstrations, and other payment reforms are key to improving access to rural healthcare, the American...

90% of Value-Based Payments in Commercial Sector Based on FFS

by Jacqueline LaPointe

The proportion of value-based payments from the commercial sector to physicians and hospitals increased from 10.9 percent in 2012 to 53.0 percent in 2017. However, an overwhelming majority of those...

CMS Accepting Applications for New Direct Contracting Models

by Samantha McGrail

The request for applications (RFA) for Medicare’s Direct Contracting Professional and Global options is now open, according to an announcement on the initiative’s CMS Innovation Center...

AMA Bolsters Healthcare Economics Training for Future Physicians

by Samantha McGrail

The American Medical Association (AMA) adopted a new policy calling on all medical schools and residency programs to include healthcare economics training related to the structure and financing of the...

Value-Based Payment Opens Doors for Better Opioid Use Disorder Care

by Jacqueline LaPointe

Nearly 64,000 Americans died from a drug overdose in 2016 alone, with opioid overdoses representing over 42,000 of those deaths, more than any previous year on record. It was that figure – as well as many other troubling statistics...

Data, Clinical Champions Key to Risk-Based Payment Model Success

by Jacqueline LaPointe

Healthcare spending is unsustainable and risk-based payment models are one of the ways to address that problem. Neither of these concepts are new to the healthcare community and have been around for...