Value-based Reimbursement

Post-Acute, At-Home Care Saves Next Gen ACO Atrius Health $19.9M

by Jacqueline LaPointe

“You can't emphasize enough the right setting and the right care,” stressed Peggy Chou, MD, the Senior Medical Director of Performance Excellence of Atrius Health in...

HHS Sets New Priorities for Physician-Focused Payment Models

by Jacqueline LaPointe

Healthcare stakeholders looking to develop their own alternative payment models for HHS implementation should look to new guidance before submitting their applications to the Physician-Focused Payment...

GAO: Advantages of Voluntary and Mandatory Bundled Payments

by Jacqueline LaPointe

Voluntary and mandatory bundled payment models each have their own pros and cons. But providers like voluntary models because they offer more favorable financial terms, a new Government Accountability...

Hospitals, Blue Cross NC Share Risk with New Value-Based Contract

by Jacqueline LaPointe

Five major health systems recently entered a value-based contract with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) that will hold them financially accountable for total costs of care...

Beta Testing Alternative Payment Models to Advance Value-Based Care

by Jacqueline LaPointe

Forcing providers to participate in alternative payment models (APMs) will do little to incentivize providers to make the care delivery and payment changes needed to reduce costs and improve quality,...

67% of MSSP ACOs May Be High-Revenue Under Pathways to Success

by Jacqueline LaPointe

Over two-thirds of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) would qualify as high-revenue organizations under the new Pathways to Success initiative, a recent...

Congress Wants More on CMMI Alternative Payment Model Development

by Jacqueline LaPointe

The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and...

Are Hospital Readmissions Reduction Program Results Overstated?

by Jacqueline LaPointe

CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the...

Social Determinants of Health Key to Value-Based Purchasing Success

by Jacqueline LaPointe

We are quickly heading to the value-based purchasing tipping point, according to the Vice President of Network Management at Health Partners Plans in Pennsylvania. “While adoption rates are...

ACO Financial Risk Rules for Pathways to Success Raise Concerns

by Jacqueline LaPointe

Leading healthcare industry groups are concerned that the overhaul of the Medicare Shared Savings Program (MSSP) will impede the transition to value-based care. On December 21, 2018, CMS finalized...

Next Generation Accountable Care Organizations Save $164M

by Jacqueline LaPointe

Accountable care organizations (ACOs) assuming the highest levels of financial risk in Medicare saved $164 million during their second performance year, CMS recently reported. Medicare ACOs bring...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs

by Jacqueline LaPointe

CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the...

Key Providers, Payers Tie 47% of Business to Value-Based Payment

by Jacqueline LaPointe

A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements. The Health Care Transformation Task Force (Task...

MSSP Accountable Care Organizations Saved Medicare Nearly $2.7B

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved more than previously thought, according to a new analysis. The updated analysis of MSSP ACO savings from the...

Value-Based Care, Price Transparency Rule Top Stories of 2018

by Jacqueline LaPointe

2018 has kept healthcare revenue cycle management and finance leaders on their toes. The healthcare industry continued its slow, but steady transition to value-based care and purchasing all while...

Healthcare Interoperability, Rule Reform Key to Value-Based Payment

by Jacqueline LaPointe

Healthcare interoperability is vital to the transition to value-based payments, the second in command at HHS recently stated at the Office of the National Coordinator for Health Information Technology...

55% of Hospitals Earn Incentive in Value-Based Purchasing Program

by Jacqueline LaPointe

More hospitals participating in the Hospital Value-Based Purchasing (VBP) Program will see a Medicare payment increase in 2019, CMS recently reported. The Hospital Value-Based Purchasing Program...

Clinicians Less Optimistic About Value-Based Care Than Execs

by Jacqueline LaPointe

Clinicians are more skeptical about the benefits or viability of value-based care and reimbursement compared to healthcare executives, a new survey shows. Only about one-third of clinicians (38...

Hospitals Seek Value-Based Contracting in Healthcare Supply Chain

by Jacqueline LaPointe

Nearly three-quarters of hospital and health system leaders are interested in value-based contracting in the healthcare supply chain, but opportunities to secure contracts with suppliers are lacking, a...

Investing in Primary Care Delivers Value-Based Care Results

by Jacqueline LaPointe

Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet...