Last month, MedPAC published a slew of data, including an update on the commission's analysis of the growing role of value-based care in the lives of Medicare FFS beneficiaries. About 200,000 Arizona Medicare beneficiaries received care through an accountable care organization in 2024, according to the latest state-level enrollment data...National News
The Centers for Medicare & Medicaid Services (CMS) has proposed sweeping updates to the Medicare Physician Fee Schedule (PFS) that would expand accountable care organizations (ACOs), sunset traditional Merit-based Incentive Payment System (MIPS) in 2029 and further shift physician reimbursement toward value-based care.
The CMS...
The next phase of value-based care may depend on specialists. A new industry toolkit from the National Association of Accountable Care Organizations (NAACOS) argues that healthcare organizations must move specialists from peripheral participants to active partners in managing cost, quality and patient outcomes, offering a framework for...
One in five American children has a chronic health condition, with even higher rates among those enrolled in Medicaid and the Children’s Health Insurance Program. The trend raises questions about how to address underlying systemic drivers and whether value-based care models can help improve outcomes for children and youth.
The...News
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)....
