The Wakely Consulting Group analysis found physician-led and lower-revenue ACOs were especially effective at generating savings as patient risk increased, outperforming larger, hospital-based ACOs managing higher risk populations.
The paper's authors also found that higher quality scores consistently correlated with stronger financial...News
A new policy brief from the influential Washington-based Paragon Health Institute warns that Congress should either reform or shut down the CMS Innovation Center, arguing the program has failed to deliver meaningful savings or quality improvements despite costing taxpayers billions. The report concludes that, after more than a decade of...
According to Milliman actuaries, the significant financial updates to the ACO REACH model for Performance Year 2026 announced in May signal CMMI’s growing concern over increased spending within the model and a pivot toward its broader strategic goals. The firm analyzes each policy change and estimates its financial impact.
Laid out...
The Centers for Medicare and Medicaid Services (CMS) has posted notice and a fact sheet for Quality Payment Program (QPP) exemptions notifying providers that the deadline for data submission has been pushed back from March 31 to April 14.
The extension does not apply to certain opt-in eligible groups or to Alternative Payment Model...
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...
The Center for Healthcare Quality & Payment Reform (CHQPR) offers steps to support its contention that value-based payment is only successful when explicitly designed to support value-based care, which the CMS Innovation Center says requires increased data sharing and the AMA warns is only possible when health systems/plans and...
After discovering widespread fraud amounting to billions of inaccurate billing for catheters, the Centers for Medicare and Medicaid Services (CMS) proposed a rule absolving participating accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP).
In 2023, CMS observed "significant, anomalous, and highly...National News
This week, Senate Finance Committee Chair Ron Wyden (D-Ore.) and ranking Republican Mike Crapo (Idaho) released a white paper requesting public input on the Medicare physician payment system, signaling that reform could be included in the year-end healthcare package that is expected to include permanent telehealth expansion.
The paper...National News
This week, America's Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of ACOs (NAACOS) released a playbook on voluntary best practices as part of their efforts together to advance the adoption of value-based care arrangements in the private sector to improve the quality, equity, and...Top of The Day
Accountable care organizations (ACOs) and their practices have taken on the full focus of Medicare's value-based care initiatives through the Medicare Shared Savings Program (MSSP) and the ACO Realizing Equity, Access and Community Health (ACO REACH) programs.
A new study published in the JAMA Health Forum looks at survey results from...National News
Open to low-revenue accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), the CMS Innovation Center will test the five-year voluntary new model focused on primary care delivery starting in 2025.
The goals of the ACO PC Flex Model are to:
Expand access to high-quality, accountable care...
A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were.
March 5, 2024
The civil suit alleges that Aledade...
According to the authors, fewer than 10% or 2,000 Skilled Nursing Facilities (SNFs) participate in ACOs, 70% of ACOs have no SNF participation, and less than 10% of ACOs account for most SNP participation.
The trade groups: The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National...
On Monday, the Centers for Medicare and Medicaid Services (CMS) announced a remarkable increase in participation in accountable care organization (ACO) programs in 2024.
The CMS press release boasts that 19 newly formed ACOs will join the new Medicare Shared Savings Program (MSSP) permanent payment option that grants ACOs $20 million...
A new study shows that accountable care organizations (ACOs) are falling short in delivering behavioral health care for Medicare beneficiaries with depression and anxiety disorders.
The study, published in Health Affairs, looked at data from the 2016-2019 Medicare Current Beneficiary Survey and isolated validated depression and...National Reports & Surveys
New studies are showing the benefits of value-based care organizations, including the rapid rise of accountable care organizations (ACOs).
Physician participation in accountable care organizations (ACOs) has increased to represent most doctors, according to a survey of 3,500 physicians by the American Medical Association (AMA)....
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule's conversion factor, setting it at $32.74, a $1.15 decrease from 2023.
The agency finalized other increases for visits including primary and longitudinal care, and...
The Health Care Payment Learning & Action Network (HCP-LAN) survey was designed to understand how widely value-based care models are being adopted as health insurance providers, clinicians, hospitals, and healthcare systems work together to move from paying for volume to value. The results include the percentage of provider payments...
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...
