With nearly 50 organizations claiming ACO status in Arizona, the market for value-based payment arrangements is accelerating, Medicare is saving and ACO profits are growing within the Medicare Shared Savings Program (MSSP) and the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.
In 2022...
This week in value-based care (VBC), the Biden Administration is making headway on its goal to reform alternative payment models (APMs) for the Medicare program to boost program savings and advance the administration's goal of health equity in medicine.
MIPS
To get a refresh on value-based care models including the Quality Payment...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...CMS Rules
On February 24, the Centers for Medicare and Medicare Services (CMS) gave a long-awaited announcement regarding the future of the Global and Professional Direct Contracting Model (GPDC). The existing model will phase out by December 31, 2022 and will be redesigned to create the Accountable Care Organization Realizing Equity, Access and...
It has been nearly a year since the Biden administration's Center for Medicare and Medicaid Innovation (CMMI) placed the Medicare Direct Contracting model (DC) under review. The Centers for Medicare and Medicaid Services (CMS) said last week that a decision on the alternative payment model (APM) would come "soon," leaving investors and...
The Direct Contracting payment model, devised under President Donald Trump's Center for Medicare and Medicaid Innovation (CMMI), grows more controversial as it has ended up in the crosshairs of Congressional progressives. But some Democrats and industry advocates support the payment model remaining on the table.
Early this month, more...National News
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...News
This week Humana signed a definitive agreement to acquire One Homecare Solutions (“onehome”) from WayPoint Capital Partners (a private equity affiliate of a family investment office). This acquisition will continue Humana’s strategy to create a value-based home health offering. One Homecare Solution's offers a variety of home-based...National News
The Biden administration has elected to discontinue the Next Generation Accountable Care Organization Model (Next Gen) at the end of 2021, to the disappointment of the National Association of Accountable Care Organizations (NAACOS). The program for accountable care organizations was originally expected to end at the beginning of the year...Arizona News
Direct Contracting has been under intense scrutiny since the Biden Administration's Centers for Medicare and Medicaid Services (CMS) put the Geographic Model on ice in early March. The National Association of Accountable Care Organizations (NAACOS) raised concerns following that announcement as 53 direct contracting entities are enrolled...National News
Nursing homes have experienced high staff turnover since the pandemic began, vaccine hesitancy among staff may be responsible for continued spread in homes, and home health care services are continuing to be highly favored over skilled nursing facilities (SNFs) among certain demographics.
Staffing shortages are up for nursing...Arizona News
The Apricus Health Network, an Arizona-based Direct Contracting Entity (DCE), is busy signing up providers and offering patients continuous care augmented by health monitoring technology and telemedicine.
Direct Contracting is a set of new payment models that are designed to allow organizations to take on more risk, and to save...National News
Due to the COVID-19 pandemic, hospices had to quickly confront and adapt to constraints on providers and patient access. These challenges, coupled with some corrective policies and new opportunities through Medicare payment models mean that things are starting to heat up in the changing industry.
Looking forward to what is still yet to...National News
On October 30, the Center for Medicare and Medicaid Innovation (CMMI) announced 51 Direct Contracting Entities (DCEs) and the implementation period for the Direct Contracting Model.
The model, called the Global and Professional Options of the Direct Contracting Model is a set of payment options which build on the idea of value-based...White Papers, E books, Reports and more
In this April 2020 assessment, Milliman provides details on the model and how advanced payments can provide an additional avenue through which direct contracting participants can generate revenue potentially equal to or greater than their shared savings.
Those primed for risk can apply to participate in a second cohort in the...National News
On Feb. 20, The National Association of Accountable Care Organizations (NAACOs) provided a laundry list of changes and recommendations to the Center for Medicare & Medicaid Innovation (CMMI) including ways to provide greater flexibility in the application process, increase shared savings rates for Professional Direct Contracting...White Papers, E books, Reports and more
Physician organizations are set to benefit the most from the Center for Medicare and Medicaid Innovation’s (CMMI) new Direct Contracting Program, offering opportunities to expand their Medicaid fee-for-service (FFS) business, while larger health systems will see a more modest impact.
A working paper published by healthcare...Arizona News
This week, public reporting has the Centers for Medicare & Medicaid Services telling Next Generation ACOs the program won't be around for 2021.
CMS says no final decision has been made and it won't be able to determine if the model can be expanded until additional performance years are evaluated.
Last month, the agency...
Dealing directly with health systems and providers is expanding from 3 percent in 2018 to 11 percent in 2019, according to a survey of 170 large employers recently released by the National Business Group on Health. The GM deal gives employees coverage for everything from doctor visits to surgical procedures. Direct contracting between...
