Alternative Payment Models

Hospital payment cap slashes prices in Ore.

March 14, 2024 - An effort to reduce healthcare spending in Oregon has successfully lowered hospital prices and variation, according to a recent study in Health Affairs. Oregon implemented a cap on hospital prices in October 2019 and January 2020, when it applied the cap to members of the state’s employee health insurance plan. The policy capped hospital...


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Consumer Advocacy Orgs Share How to Move Away From Fee-For-Service Payment

by Victoria Bailey

As healthcare spending rises, shifting away from fee-for-service payment and delivery models that incentivize volume over value is imperative. Families USA and other consumer advocacy groups are urging...

New Medicaid Payment Model Targets Behavioral Health Integration

by Jacqueline LaPointe

CMS has announced a new Medicaid payment model that will incent care coordination across physical, behavioral, and social providers to improve the quality of care Medicare and Medicaid beneficiaries...

Understanding the Basics of Bundled Payments in Healthcare

by Editorial Staff

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment...

CMS Model Aims to Improve Maternal Health Outcomes, Access to Care

by Victoria Bailey

CMS has launched a new care delivery model to address maternal health outcomes and increase pregnancy and postpartum care access. The Transforming Maternal Health (TMaH) model will run for ten years...

Understanding the Value-Based Reimbursement Model Landscape

by Editorial Staff

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...

Understanding the Fundamentals of Accountable Care Organizations

by Editorial Staff

The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many value-based care models, accountable care organizations (ACOs) are...

How Vermont’s All-Payer ACO Model Paves the Way for Value-Based Care

by Victoria Bailey

As its name states, the Vermont All-Payer Accountable Care Organization (ACO) Model is an arrangement that incorporates patients with both private and public healthcare coverage, but what makes this model so appealing to providers? Is this...

NAACOS: Medicare Payment Incentives Favor Clinicians in Fee-For-Service

by Victoria Bailey

Medicare payment incentives favor clinicians participating in fee-for-service models rather than those in advanced alternative payment models (APMs), according to the National Association of...

CMS Updates ACO REACH Model for 2024 to Improve Health Equity

by Victoria Bailey

CMS has announced revisions to the ACO Realizing Equity, Access, and Community Health (ACO REACH) model to improve health equity and predictability for participants. CMS replaced the Direct...

CMS Will Test APM for Medicare Beneficiaries with Dementia, Caregivers

by Victoria Bailey

CMS has announced plans to test an alternative payment model (APM) to support Medicare beneficiaries with dementia and their unpaid caregivers. The Guiding an Improved Dementia Experience (GUIDE)...

Most Practices Not Joining Enhancing Oncology Model, Survey Finds

by Victoria Bailey

Most oncology practices are not planning to participate in the Enhancing Oncology Model (EOM), citing concerns about the risk arrangements and inadequate incentive payments, a survey from the Community...

Community Service Navigation Helped Reduced Emergency Department Use

by Victoria Bailey

The CMS Accountable Health Communities (AHC) Model reduced emergency department (ED) use for Medicare and Medicaid beneficiaries but did not help resolve health-related social needs (HRSNs) issues as...

Benchmark Regionalization in MSSP Disincentivized Higher-Spending ACOs

by Victoria Bailey

After CMS began incorporating regional spending into accountable care organization (ACO) benchmarks in the Medicare Shared Savings Program (MSSP), more higher-spending ACOs exited the program, a study...

The Most Successful Alternative Payment Models from CMMI, To Date

by Jacqueline LaPointe

The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its...

Value-Based Payment Models May Help Curb High Healthcare Spending

by Victoria Bailey

As healthcare spending escalates in the US, stakeholders have started looking at value-based payment models to address rising costs, but many payments are still tied to fee-for-service models,...

Advanced Bundled Payment Model Reduced Payments for High-Risk Patients

by Victoria Bailey

Hospital participation in Medicare’s Bundled Payment for Care Improvement Advanced Model (BPCI-A) decreased Medicare payments and did not negatively impact health outcomes for high-risk patients,...

ETC Model Did Not Significantly Boost Home Dialysis Rates

by Victoria Bailey

The End-Stage Renal Disease Treatment Choice (ETC) model did not increase home dialysis rates, despite the financial incentives it provides clinicians to offer this type of care, according to a study...

Cancer Care Alternative Payment Model Didn’t Reduce Novel Drug Use

by Jacqueline LaPointe

Clinicians participating in alternative payment models must keep a close eye on the cost of care. However, that is not at the expense of novel anticancer drug use in the Oncology Care Model (OCM), a...

APMs Support Better Primary Care, But Value-Based Care Obstacles Remain

by Jacqueline LaPointe

Primary care practices in Medicare’s Comprehensive Primary Care (CPC) and CPC+ models made meaningful care delivery changes compared to non-participating practices, making the case for...