Capitated Payments

Understanding the Value-Based Reimbursement Model Landscape

December 11, 2023 - The Centers for Medicare and Medicaid Services (CMS) aims to have all traditional Medicare beneficiaries under a value-based care model by 2030. Although the pace may be slow, the healthcare industry is shifting away from fee-for-service payments toward value-based reimbursement models. According to the Health Care Payment & Learning Action Network (LAN), over half of healthcare...

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NAACOS: Medicare Shared Savings Program Needs Full-Risk Option

by Victoria Bailey

A full-risk option in the Medicare Shared Savings Program (MSSP) would offer accountable care organizations (ACOs) additional flexibility and more capitation options, according to the National...

Should Population-Based Payments Account for Social Risk Factors?

by Jacqueline LaPointe

Efforts to make the healthcare system more efficient and equitable by adjusting population-based payments for social risk factors may be missing the mark, suggests a new study from Harvard and Yale....

Shared Financial Risk Lowered Healthcare Costs for CA Residents

by Victoria Bailey

California residents and health systems saw lower healthcare costs and higher clinical quality when providers and payers shared financial risk, according to data from the Integrated Healthcare...

Surgical Costs, Complications Slowed Under MD’s All-Payer Model

by Jacqueline LaPointe

An all-payer model that puts caps on hospital spending has slowed surgical spending and the rate of avoidable complications across major surgical procedures, according to a recent study published in...

How Morgan Health is Paving the Way for Advanced Primary Care

by Jacqueline LaPointe

Advanced primary care tied to a person-level payment model is key to improving outcomes and reducing costs, at least according to the Duke Margolis Center for Health Policy and Morgan Health, a new...

Hybrid Primary Care Payment Structure Crucial to Quality Care

by Jill McKeon

High quality, patient-centered care requires a hybrid primary care payment system that encourages value-based care and physician quality assurance, according to an opinion article published recently in...

CMS Stops Accepting New Direct Contracting Applications

by Jacqueline LaPointe

CMS has announced that it will not be soliciting any more applications for the Global and Professional Direct Contracting Models slated to launch on January 1, 2022. Organizations that had already...

Low-Value Care Spending Slows as Medicare Pushes Value-Based Care

by Hannah Nelson

Low-value care spending among fee-for-service Medicare recipients dropped slightly from 2014 to 2018. However, two of the three services that make up the majority of low-value healthcare spending,...

ACOs, Population-Based APMs Most Effective at Lowering Costs

by Jacqueline LaPointe

If CMS aims to lower healthcare costs and improve quality, then the agency should use more population-based alternative payment models, like accountable care organizations (ACOs), according to a new...

Key Considerations for Providers Thinking of Capitation Payments

by Jacqueline LaPointe

More providers are thinking of switching to capitation payments in light of the COVID-19 pandemic. However, the decision should not be taken lightly; provider organizations need to consider the major...

51 Organizations Join New Direct Contracting Opportunity from CMS

by Jacqueline LaPointe

CMS recently announced that 51 organizations will take part in a new directing contracting opportunity that will test what the agency calls the “next evolution of risk-sharing...

PCPs Paid Under Global Capitation Deliver Higher Quality Care

by Jacqueline LaPointe

Global capitation payments provide strong incentives for primary care physicians to achieve key quality metrics, including cancer screening and medication review, UnitedHealth Group concluded from new...

CMS Unveils New Value-Based Care, ACO Options for Rural Providers

by Jacqueline LaPointe

A new rural health model recently unveiled by CMS will offer rural providers and their communities new funding opportunities to bolster value-based care through capitated payments and accountable care...

Medicaid Alternative Payment Model Reduces Imaging, Costs

by Jacqueline LaPointe

A Medicaid alternative payment model in Oregon reduced utilization of imaging and other traditional primary care services among community health centers by about 42 percent, according to an Oregon...

How COVID-19 Imperiled Physician Practices, And How to Save Them

by Jacqueline LaPointe

Some have heard the ringing of the death knell for physician practices for years now. Mergers and acquisitions, industry consolidation, value-based care, and the growing presence of private equity firms in healthcare have all threatened...

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...

NY Medicaid Program Bringing Value-Based Payment to Pediatrics

by Jacqueline LaPointe

New York is overcoming the challenges of developing value-based payment models for pediatrics to bring value to the approximately 1.8 million children enrolled in its Medicaid program, according to a...

Atrius Health Makes the Business Case for Risk-Based Payments

by Jacqueline LaPointe

At a time when operating income is falling for most hospitals and practices, Atrius Health, Inc., the largest non-profit independent medical group in New England, is reporting a $38.7 million operating...

Financial Risk Sharing in Healthcare Improves Quality, Costs in CA

by Jacqueline LaPointe

Financial risk sharing in healthcare led to total costs of care being 3.5 percent lower in 2017, reveals the third edition of the California Regional Health Care Cost & Quality Atlas. Providers in...

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