Value-based Reimbursement

Financial Incentives Biggest Barrier to Social Determinants of Health

by Emily Sokol, MPH

The success of social determinants of health strategies is contingent on funding and supportive financial incentives, providers revealed in Insights by Xtelligent Healthcare Media’s latest...

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...

Most Facilities in Hospital Readmissions Reduction Program Penalized

by Jacqueline LaPointe

The majority of facilities participating in the Hospital Readmissions Reduction Program (HRRP) in fiscal year (FY) 2021 have been penalized for readmitting too many patients according to CMS...

CMS Releases Initial Quality Payment Program Results for 2019

by Jacqueline LaPointe

Eligible clinicians overwhelmingly participated in the Quality Payment Program despite facing challenges caused by the COVID-19 pandemic, according to preliminary data from CMS. CMS announced in a...

CMS Pushes Back Launch of Radiation Oncology Model

by Jacqueline LaPointe

CMS recently announced via email that it intends to delay the start of the Radiation Oncology Model after receiving feedback from stakeholders. “CMS has received feedback from a number of...

Designing Alternative Payment Models for Health System Resiliency

by Jacqueline LaPointe

Alternative payment models that use population-based payments to incent providers to deliver coordinated, high quality, person-centered care are key to building healthcare system resiliency after a...

Top 10 Accountable Care Organizations by Shared Savings in 2019

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Medicare Shared Savings Program collectively saved $2.6 billion in 2019, netting Medicare $1.19 billion, according to the latest program performance...

How Top Accountable Care Organizations Save Year After Year

by Jacqueline LaPointe

Accountable care organizations had a record year, according to the latest performance data for the Medicare Shared Savings Program. CMS recently announced that organizations participating in the program – which are otherwise known...

CMS Finalizes Alternative Payment Models for Specialty Care

by Jacqueline LaPointe

CMS is transitioning more specialty care to value-based reimbursement with two new alternative payment models for end-stage renal disease and cancer care. A final rule released late last week unveiled...

Multi-Payer Alignment Key to Advancing Value-Based Care in Medicaid

by Jacqueline LaPointe

In a new letter to Medicaid directors, CMS called for multi-payer alignment in value-based care arrangements run by the state healthcare programs. The Sept. 15th letter providers guidance to the...

Major Changes Coming to BPCI Advanced Clinical Episodes, Prices

by Jacqueline LaPointe

CMS is making major changes to Bundled Payments for Care Improvement (BPCI) Advanced next year to stop the model from generating financial losses of close to $2 billion over the model’s ten...

Telehealth Reimbursement Just for Value-Based Providers Post-COVID?

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) is the latest group to weigh telehealth reimbursement expansions after the COVID-19 pandemic. In a meeting held virtually last week, MedPAC analysts...

Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

by Jacqueline LaPointe

Clinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received...

Coronavirus Pandemic Impacts Value-Based Contracts

by Emily Sokol, MPH

The coronavirus pandemic highlighted the importance of value-based contracts and reimbursement and will continue to push the industry towards these models of care, according to healthcare stakeholder...

Home Health Payments Much Lower Than Expected Under New Model

by Jacqueline LaPointe

Medicare reimbursement cuts meant to keep home health payments levels during the transition to a patient-based payment system have actually resulted in significant revenue decreases for the providers,...

Healthcare Providers Did Not Take On More Financial Risk in 2019

by Jacqueline LaPointe

Nearly half of healthcare executives said 10 percent or less of their organization’s revenue came from risk-based contracts in 2019 despite expectations that financial risk in healthcare would be...

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...