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

Value Based Reimbursement

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

October 9, 2017 - 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 from the National Association of ACOs (NAACOS) and Leavitt Partners. Shared in a Health Affairs blogpost, the survey findings also revealed that Medicare,...


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Do Alternative Payment Models Overcome Fee-for-Service Flaws?

by Jacqueline Belliveau

While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according to...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline Belliveau

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to further transition...

Prioritizing Value-Based Care, Affordability in Medicaid

by Jacqueline Belliveau

WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on Medicaid....

Payer, Provider Collab, Home Health Key to Integrated Care

by Jacqueline Belliveau

WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle, Humana’s CEO and President Bruce D. Broussard...

Bringing Back House Calls to Cut Spending on High-Risk Patients

by Jacqueline Belliveau

Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls dropped...

Cost Data to Improve Quality Reporting, Value-Based Purchasing

by Jacqueline Belliveau

Providers enter value-based purchasing contracts without understanding the cost of quality reporting on measures listed in their contracts and payers rarely use cost data to determine which metrics to use when linking reimbursement to...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline Belliveau

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in an...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline Belliveau

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers have recently...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline Belliveau

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient, high-quality...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline Belliveau

The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the industry...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

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...

Physician Expert, Clinical Documentation Key to MIPS Success

by Jacqueline Belliveau

Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA have...

Small Health System Achieves ROI with Asthma Management Clinic

by Jacqueline Belliveau

Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on investment...

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...

NQF Eyes Adding Social Risk Factors to Value-Based Purchasing

by Jacqueline Belliveau

In response to stakeholder concerns that value-based purchasing programs unfairly penalize providers who treat greater proportions of disadvantaged patients, the National Quality Forum (NQF) recently endorsed 17 quality measures that address...

Do Oncology Bundled Payments Promote Low-Value Drug Use?

by Jacqueline Belliveau

Oncology bundled payments are not the answer to lowering prescription drug costs for cancer care delivery, the American Society of Clinical Oncology recently contended. In a position statement on addressing the affordability of cancer drugs,...

Is a Chief Primary Care Officer Key to Value-Based Purchasing?

by Jacqueline Belliveau

Developing a Chief Primary Care Medical Officer role should help health systems achieve value-based purchasing success by focusing on establishing care coordination systems and improving key quality measures, argued industry experts in a recent...

3 Challenges Providers Face with Healthcare Bundled Payments

by Jacqueline Belliveau

Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or improving...

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