Alternative Payment Models

Radiation Oncology Bundle Inaccurately Predicts Some Cancer Costs

by Samantha McGrail

A proposed bundled payment model for radiation oncology cold underestimate payments for prostate cancer, a new analysis from Avalere,  finds.  The healthcare consulting firm based in...

Partners, Patients Key to Achieving Value-Based Care Results

by Jacqueline LaPointe

For over a decade, the healthcare industry has been shifting provider reimbursement from a fee-for-service system to one based on the value of services provided to patients, and new payment models have...

CMS Opens Apps for Kidney Care Model, Delays Primary Care First

by Jacqueline LaPointe

Late last week, CMS started to accept applications for two new alternative payment models focusing on kidney and primary care, with the latter now facing a delayed implementation. Both the Kidney Care...

Healthcare Price Transparency, APMs Fail to Control Costs in MA

by Samantha McGrail

Despite aiming to reduce costs and help consumers shop for quality, affordable medical services, healthcare price transparency tools in Massachusetts are not working as intended, according to a new...

36% of Payments Tied to Alternative Payment Models in 2018

by Jacqueline LaPointe

The healthcare industry is slowing phasing out fee-for-service payments for alternative payment models (APM), according to the latest APM Measurement Effort report from the Health Care Payment Learning...

More States Require Value-Based Reimbursement in Medicaid

by Samantha McGrail

The number of states with Medicaid managed care requiring value-based reimbursement as part of the public healthcare program increased from 22 out of 39 states in 2017 to 28 out of 40 states by 2019, a...

HHS Endorses Alternative Payment Model for Emergency Medicine

by Samantha McGrail

ACEP, an association representing 40,000 emergency physician members, developed and submitted the Acute Unscheduled Care Model (AUCM) to HHS’ Physician-Focused Payment Model Technical Advisory...

Physician-Led ACOs Saved More Than Hospital ACOs in 2018

by Jacqueline LaPointe

Physician-led accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) produced nearly seven times the savings per beneficiary than hospital-led ACOs, a new analysis...

Advocate Aurora Invests in People, Infrastructure for ACO Success

by Jacqueline LaPointe

Accountable care organization (ACO) success was no stranger to physicians at Advocate Health Care and Aurora Health Care. Now that the two major health systems are combined, the new...

CMS Says Clinicians to Receive Advanced APM Bonus Payments Soon

by Jacqueline LaPointe

In a fact sheet created on Sept. 27, CMS announced that Advanced Alternative Payment Model (APM) bonus payments for participation in an approved model in 2017 will be going out to qualifying clinicians...

Provider Incentives, M&A to Accelerate Value-Based Care Adoption

by Jacqueline LaPointe

Healthcare providers and other industry leaders are still facing significant challenges with value-based care adoption, but provider incentives and market consolidation could help accelerate the...

Medicare Shared Savings Program ACOs Saved $739M in 2018

by Jacqueline LaPointe

Accountable care organization (ACOs) in the Medicare Shared Savings Program saved $739.4 million in 2018 after accounting for shared savings and losses that year, according to program data released by...

Industry Group Ties Half of Business to Value-Based Payments

by Jacqueline LaPointe

Payer and provider members belonging to a group of leading healthcare stakeholders have increased the amount of business under value-based payments, even surpassing the 50 percent mark by the end of...

Stakeholders Criticize Payments, Measures in Mandatory ESRD Model

by Jacqueline LaPointe

Dialysis centers, major health systems, and other industry stakeholders are calling on CMS to reconsider a proposed end-stage renal disease (ESRD) model that will put providers at risk for at-home...

54% of Physicians Participate in an Accountable Care Organization

by Jacqueline LaPointe

The majority of physicians now participate in an accountable care organization (ACO), the American Medical Association (AMA) recently reported. Overall, 53.8 percent of physicians polled in September...

Reimbursement Adequacy, Timely Data Needed for Risk-Based Payment

by Jacqueline LaPointe

Reimbursement inadequacy, timeliness of data, and access to data are preventing hospitals and health systems from moving to risk-based payment, according to a recent survey from healthcare improvement...

Stakeholders Pick Apart Bundled Payments for Radiation Oncology

by Jacqueline LaPointe

The American Hospital Association (AHA), Community Oncology Alliance (COA), and other key stakeholders voiced concerns about a mandatory bundled payments model for radiation oncology slated to take...

ACO Participation Dipped After Pathways to Success, NAACOS Finds

by Jacqueline LaPointe

The latest accountable care organization (ACO) participation numbers for the Medicare Shared Savings Program (MSSP) raise concerns for the National Association of ACOs (NAACOS). In a recent Health...

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

by Jacqueline LaPointe

CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower...

Chronic Disease Patients with Mental Health Disorders Cost More

by Jacqueline LaPointe

For chronic disease patients, having a mental health disorder was associated with higher healthcare costs and resource use, confirms a new study in JAMA Network Open. The study of hospitalization and...