Value-based Reimbursement

72% of Execs Ready for Risk-Based Alternative Payment Models

by Jacqueline LaPointe

Providers are gearing up to participating in risk-based alternative payment models through commercial payers and Medicare, according to a new Navigant analysis based on a survey conducted by the...

Manual Healthcare Contract Management Costs Providers $157B A Year

by Jacqueline LaPointe

Healthcare contract management is still largely manual or non-existent for most providers, revealed a new Black Book survey. Ninety-six percent of the 1,275 CFO, financial management, and business...

Social Determinants of Health, APMs Coming Up at AHIP Institute

by Jacqueline LaPointe

NASHVILLE – AHIP’s Institute & Expo (AHIP Institute) conference always promises to bring the top experts from payer organizations to share how their plans and providers are adjusting to...

COA Proposes New Oncology Care Model with Value-Based Purchasing

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently submitted an alternative payment model proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) that builds on the work done by...

AMA Seeks Alternative Payment Models for Vulnerable Populations

by Jacqueline LaPointe

In an effort to reduce healthcare disparities, the American Medical Association (AMA) recently vowed to support the creation of new alternative payment models that specifically address the outcomes of...

3 Strategies to Help Accountable Care Organizations Boost Savings

by Jacqueline LaPointe

Accountable care organizations (ACOs) have come a long way since the Affordable Care Act (ACA). Providers have formed over 1,000 ACOs covering over 32 million patients since the law paved the way for...

Practices Ask for Downside Risk Delay for Oncology Care Model

by Jacqueline LaPointe

An association of community oncology practices recently urged CMS to delay the October 2019 deadline for practices in the Oncology Care Model (OCM) to assume downside financial risk. In a letter to...

Accountable Care Organizations Lower Costs Compared to HMOs, PPOs

by Jacqueline LaPointe

Commercial accountable care organizations (ACOs) in California are outperforming two common provider network arrangements in terms of care quality and total cost of care, according to a recent analysis...

AHA Seeks More on Primary Cares Initiative’s Direct Contracting

by Jacqueline LaPointe

CMS’ request for information on a new direct contracting model presents a unique opportunity for financial risk in healthcare, but the “lack of detail makes it difficult for providers to...

70% of Practices to Owe Under Risk Tracks in Oncology Care Model

by Jacqueline LaPointe

Seventy percent of practices in Medicare’s Oncology Care Model (OCM) would owe payments to CMS if they transition to the program’s two-sided financial risk tracks, a new Avalere analysis...

Risk-Based Revenue Gains Momentum Among Providers, AMGA Finds

by Jacqueline LaPointe

Risk-based revenue from medical groups and integrated delivery systems (IDNs) accounted for 56 percent of revenues in federal settings and 28 percent of revenues in commercial settings in 2018,...

Medicaid ACO Growth Still Lags Behind Medicare, Commercial Payers

by Jacqueline LaPointe

Medicaid accountable care organizations (ACOs) have not grown as quickly as industry experts anticipated, according to a new report from Leavitt Partners. ACOs with at least one Medicaid contract...

CPC+ Did Not Cut Medicare Spending, Improve Quality in First Year

by Jacqueline LaPointe

The Comprehensive Primary Care Plus (CPC+) did not affect total Medicare spending, and the value-based reimbursement program for primary care practices had little impact on service use and care...

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...

Exploring Value-Based Payment Models Under Primary Care First

by Jacqueline LaPointe

On April 22, 2019, HHS unveiled the Primary Cares Initiative, a program that aims to reduce administrative burdens and enable primary care providers to focus more time on patients while decreasing...

Providers, Execs Applaud Medicare’s Primary Cares Initiative

by Jacqueline LaPointe

Provider groups and healthcare executives are on board with Medicare’s new Primary Cares Initiative, which will shift primary care from fee-for-service to at-risk value-based reimbursement models...

HHS Launching Direct Contracting Payment Models for Primary Care

by Jacqueline LaPointe

HHS recently announced that CMS will launch the Primary Cares Initiative in 2020, which will give about one in four primary care providers the opportunity to receive value-based reimbursement and...

48 States Running Value-Based Reimbursement, Care Initiatives

by Jacqueline LaPointe

Forty-eight states have implemented value-based reimbursement or care programs as of February 2019, representing a seven-fold increase compared to five years ago, a new Change Healthcare study...

What Independent Practices Need to Thrive Under Value-Based Care

by Jacqueline LaPointe

Providers and owners of independent practices often view value-based care as a trojan horse. Value-based care promises to improve care quality and lower costs compared to fee-for-service, but...

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