Risk Management News

Study Can’t Link Hospital Competition to Quality Improvements

August 15, 2023 - A study out of the University of Michigan cannot identify a clear relationship between surgical outcomes and the level of competition a hospital faces. The study recently published in JAMA Surgery analyzed Medicare Provider Analysis and Review files (MEDPAR) between 2015 and 2018, which included data on beneficiary index admission for a procedure...


Articles

Shared Financial Risk Lowered Healthcare Costs for CA Residents

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California residents and health systems saw lower healthcare costs and higher clinical quality when providers and payers shared financial risk, according to data from the Integrated Healthcare...

Supply Chain, Labor Inflation Poses Risk to Healthcare Profit Margins

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According to a Fitch Ratings report, supply chain challenges and rises in labor are leading to higher costs and potential revenue loss, threatening profit margins for healthcare and pharmaceutical...

Health Systems Set Sights on Risk-Based Payment in Medicare Advantage

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Health systems are planning to advance their risk-based payment strategies by taking on more upside or downside risk, professional capitation, or global capitation in Medicare Advantage lines of...

Key Characteristics for Successful Downside Risk Contracting

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Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working...

10 ACOs with the Highest Shared Savings Payments in 2020

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The Medicare Shared Savings Program (MSSP) saved over $4 billion in 2020. Between the $1.9 billion in Medicare savings and $2.3 billion in accountable care organization (ACO) savings, this represents...

AMGA to CMS: Rethink ACO Financial Risk Advancement in MSSP

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The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a...

Risk Stratification Of Bundled Payment Models Requires Clinical Data

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Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis. The OCM is a...

Preparing Physician Practices for Direct Contracting, Risk Models

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Physicians want three things, according to Anthony Valdés, President of Collaborative Health Systems, and those are to deliver great clinical outcomes, get paid fairly for that...

Healthcare Providers Did Not Take On More Financial Risk in 2019

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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...

Practices in Oncology Care Model Ready to Assume Two-Sided Risk

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Oncology practices participating in CMS’ Oncology Care Model (OCM) are willing to take on two-sided risk, according to a survey conducted by the Community Oncology Alliance (COA).  The...

ACOs Enrolled in MSSP Assume Downside Risk as the Program Matures

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More accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) have assumed downside risk as the program progresses, according to a new Avalere analysis. Most...

NAACOS Establishes Direct Contracting Taskforce

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The National Association of Accountable Care Organizations (NAACOS) recently announced the formation of the Direct Contracting Taskforce, which offered tools for participation in the latest accountable...

7 MI Providers Take on Shared Risk Payment Model with Blue Cross

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Seven healthcare organizations in Michigan recently signed on to participate in a new shared-risk payment model with Blue Cross Blue Shield of Michigan that will hold the providers accountable for...

CMS Accepting Applications for New Direct Contracting Models

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The request for applications (RFA) for Medicare’s Direct Contracting Professional and Global options is now open, according to an announcement on the initiative’s CMS Innovation Center...

Data, Clinical Champions Key to Risk-Based Payment Model Success

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Healthcare spending is unsustainable and risk-based payment models are one of the ways to address that problem. Neither of these concepts are new to the healthcare community and have been around for...

Reimbursement Adequacy, Timely Data Needed for Risk-Based Payment

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Reimbursement inadequacy, timeliness of data, and access to data are preventing hospitals and health systems from moving to risk-based payment, according to a recent survey from healthcare improvement...

ACO Participation Dipped After Pathways to Success, NAACOS Finds

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The latest accountable care organization (ACO) participation numbers for the Medicare Shared Savings Program (MSSP) raise concerns for the National Association of ACOs (NAACOS). In a recent Health...

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

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CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower...

MSSP Sees Drop in New ACO Participation Under Pathways to Success

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CMS selected 206 accountable care organizations (ACOs) to participate in the Medicare Shared Savings Program (MSSP) under Pathways to Success, including 41 entirely new ACOs and 25 re-entering the...