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...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...Open
A new study found accountable care organizations (ACOs) role in Medicaid is directly related to improved health outcomes and improvements in healthcare quality, but regulation and competing policies stand in the way of their full adoption in the program.
Medicaid ACOs are established in 14 states, but their adoption remains slow and...Arizona News
The partnership kicks off in the New Year, Jan. 1, 2023, and is expected to bring improved patient and provider services to PathfinderHealth primary care practices in northern Arizona, and help PathfinderHealth, a clinically integrated network and accountable care organization (ACO), navigate the transformation to value-based healthcare...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) has released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) final rule that reduces payments by almost 4.5% YOY and includes substantive changes for ACOs in the Medicare Shared Savings Program, expands access to behavioral health services, and decreases the conversion factor...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) published the proposed 2023 physician fee schedule (PFS) which included an overhaul to the agency's strategies on accountable care organizations (ACOs) through the Medicare Shared Savings Program (MSSP).
In February, CMS pulled the Accountable Care Organizations...
Last Wednesday, the Medicare Payment Advisory Commission (MedPAC) published its biennial report to Congress which included recommendations to streamline alternative payment models (APMs) within the Medicare program. It also recommended a strategy to improve accuracy in Medicare Advantage (MA) payments and correct a major contributor to...
This week in value-based care, a fresh look at untangling VBC for providers looking to enter into an ACO or payment model, results from the Comprehensive ESRD Care Model, and some market moves in long-term and home healthcare.
A new study published in Health Affairs on Monday demonstrates that the first Medicare accountable care...