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...National News
Value-based care is now a ubiquitous term across the medical industry, primarily led by Medicare payment models that prioritize quality of care above overall cost. But some are questioning the concept's utility and expanse over the Medicare market.
Legislation proposed in both the U.S. House of Representatives and Senate would...
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...
In a Valentine's Day letter to HHS Secretary Xavier Becerra, healthcare organizations including the National Association of ACOs, Arizona healthcare providers, medical practices, Direct Contracting Entities (DCEs) and ACOs urged him not to break up with the GPDC model but instead make, "necessary refinements to improve the model in...
Today, the Centers for Medicare & Medicaid Services (CMS) released data showing that Accountable Care Organizations (ACOs) are serving a growing patient population as accountable care advocates wait to see what participation is like in the new Direct Contracting Model.
According to CMS, 13 Accountable Care Organizations (ACOs)...
Pioneering health care data services and technologies have the potential to revolutionize the delivery of care by allowing providers and insurers to focus on the individual needs of every patient and the health-impacts of their environment. But getting things right takes time and some insurers are having a difficult time reigning in...
The National Association of Accountable Care Organizations (NAACOS) sent a letter to Representatives Derek Kilmer (D-WA), Kathleen Rice (D-NY) and Adrian Smith (R-NE) in support of a bill sponsored by the bipartisan group that would remove a statutory requirement that patients have at least one primary care visit with a physician during...Arizona News
Last Tuesday, providers gathered in Washington, D.C. to advocate against the Medicare direct contracting program, arguing that it could become the end of Medicare.
Members of Physicians for a national Health Program (PNHP), which supports a single-payer healthcare system brought petitions to appeal to U.S. Department of Health and...CMS Rules
On Tuesday, the Centers for Medicare and Medicaid Services issued a final rule for the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS). The PFS includes policy changes for Medicare payments and Medicare Part B, and is the major mechanism for rate setting for the Medicare program as a whole. The PFS must remain budget...National News
Last week, the National Association of ACOs (NAACOS) sent a letter to the Centers for Medicare and Medicaid Services (CMS) requesting leniency regarding performance benchmarks and the potential option for accountable care organizations to select pre-pandemic years as the basis for benchmark measurements. Additionally, CMS announced the...Arizona News
Accountable Care Organizations (ACOs) served 12.1 million Medicare fee-for-service beneficiaries and saved the nation's biggest payer about $1.9 billion in 2020, the fourth year of net savings. In Arizona, 11 ACOs participated in the Medicare Shared Savings Program (MSSP) taking on a mix of one-sided and two-sided risk, but only six...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...
