The transition to value-based care has been ongoing for years. Although advances have certainly been made over the past decade, many have noticed that the switch is taking quite a while. This week, several experts and organizations weigh in on why the transition is slow, and what could speed it up.
Consistently, the leading issues...
The Medicare Shared Savings Program (MSSP) is one of the country's largest value-based payment programs, serving nearly 11 million Medicare beneficiaries. In 2023, the program saved Medicare $2.1B, the largest savings in the program's history. In Arizona, 17 MSSP Accountable Care Organizations (ACOs), some which serve several states...
Most accountable care organizations (ACOs) participating in the final year of the Global and Professional Direct Contracting (GPDC) Model earned shared savings of while 23% reported losses in 2022. Collectively, the ACOs generated $870 million in gross savings after accounting for shared savings and losses and discounts paid, a 700%...
For the first time ever, all ACOs operating in Arizona earned shared savings as participants in the Medicare Shared Savings Program (MSSP) in 2022.
Nationally, the MSSP saved Medicare $1.8 billion in 2022 compared to spending targets for the year. This marks the sixth consecutive year the program has generated overall savings and...National News
A slew of changes will impact REACH ACOs including reduced beneficiary alignment minimums from 5,000 to 4,000 for new entrants along with a 10% beneficiary alignment buffer for all participants to provide more wiggle room for temporary enrollment fluctuations. The agency also announced changes this week to protect against inappropriate...National News
Last year, the Centers for Medicare and Medicaid Services (CMS) announced a roadmap for its strategic vision and priorities to expand equitable access to health coverage and promote value-based, person-centered care. The Center for Medicare and Medicaid Innovation (CMMI) illustrated its vision through five main objectives to guide its...National News
At this time two years ago, the future of alternative payment models (APMs) and accountable care organizations (ACOs) was uncertain and to some degree the entire landscape of value-based care hung in the balance while the Trump administration sorted out the details of the Direct Contracting payment models. But now, under the Biden...
More than a dozen pages cover what you need to know about Advanced Payment Models (APMs) including Accountable Care Organizations (ACOs), Direct Contracting Entities (DCEs) and Value-based Networks (VBNs) competing for Primary Care Physicians (PCPs) and beneficiaries in Arizona. Taking risk for the quality and cost of care is making...
This week, the Center for Medicare hinted at new value-based approaches to palliative care; health equity takes precedence in the national conversation on rural payment models; and value-based contracts are analyzed for their ability to mitigate drug costs.
The Medicare Shared Savings Program (MSSP) is now ten years old, and with it...National News
In late February, the Centers for Medicare and Medicaid Services (CMS) announced that after a full year of review, it would overhaul the Global Professional Direct Contracting Model and create the Accountable Care Organization (ACO) Realizing Equity, Access and Community Health (REACH) model. The redesign was intended to address...Arizona News
Value-based payment arrangements are rapidly growing with several Arizona-based companies either joining national programs or expanding value-based design to other areas of the country. The National Association of Accountable Care Organizations (NAACOS) says that bigger changes can't come fast enough.
In a press release last week,...News
In light of a pandemic which dramatically exposed serious racial health inequities in the U.S., researchers and healthcare providers are working to better understand this complex problem and begin the daunting task of solving it.
This week, Kaiser Health News published an interview with Dr. Paula Braveman, director of the Center...National News
This week, industry stakeholders discussed value-based care as it pertains to their business and said in no uncertain terms that the path forward for healthcare is through value-based care, with the Centers for Medicare & Medicaid Services' (CMS) alternative payment models (APMs) leading the way. Skilled nursing facilities and...National News
A new bill introduced by Representatives Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) looks to reverese Trump-era modifications to the Medicare Accountable Care Organization (ACO) program and restore higher cost savings to participating providers while removing some of the risk. The bill...National News
CMS Administrator Seema Verma announces that value-based payment models are important to the future of the US healthcare system and that they will be flexible regarding their financial models, reporting requirements and timelines.
The CMS Center for Medicare and Medicaid Innovation (CMMI) celebrates its tenth year of driving new...CMS Rules
Accountable care organizations (ACOs) are asking for more support from the Trump administration amid the pandemic. ACOs want more time to decide on whether to voluntarily exit the Medicare Shared Savings Program (MSSP) as coronavirus-related financial losses and balance sheet deficits pile up.
With payments tied to spending and...Arizona News
As the novel coronavirus wreaks havoc on global economic data, risk-bearing Accountable Care Organizations (ACOs) are worried the pandemic could threaten a decade-long shift to value-based payment models. Many facilities are struggling to stay in business as a fast-approaching May 31 deadline to give notice to the Administration in...Arizona News
After rebranding the MSSP to the Pathways to Savings in 2018, CMS reported about 11.2 million Medicare beneficiaries are now served by 517 ACOs participating in the shared savings program, and 200 are taking downside risk.
Only 35 new ACOs joined the revamped Medicare Shared Savings Program (MSSP) in 2020, far below the annual...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) recently issued a request for applications (RFA) for two of the three voluntary payment model options, specifying how accountable care organizations can apply to participate in the professional and global options of Direct Contracting (DC).
Defined within DC are three different...Arizona News
In a recent study, the American Journal of Managed Care (AJMC) investigated the rate of utilization and spending under Banner Health's Medicare and commercial insurance contracts in Maricopa County.
The amount of financial risk assumed by the delivery system under the contracts varied and study authors found that within Medicare,...
