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...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...
CMS is signaling its next chapter in value-based care; in a newly released white paper, the agency outlined its 2025 strategy and beyond, doubling down on prevention, patient engagement, and competition. CMS also announced this week upcoming changes to ACO REACH’s financial methodology based on the agency's review of REACH ACO's first...
Rising consumer healthcare costs and increasing commercial reimbursement rates, impacts of the IRA, along with MSSP & REACH ACO shadow bundles and MA agent compensation data - if you can measure it, Milliman had an article, news brief or white paper on it in 2023; we're highlighting a few of our newsroom favorites.
Milliman is a...
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...Arizona News
Last week the Centers for Medicare and Medicaid Services released the names and benefit parameters of 2024 REACH ACO organizations serving millions of Medicare beneficiaries. REACH ACOs select from one of two risk options; most (103 ACOs) chose Global (100% risk for shared savings/losses) and 19 ACOs selected Professional (50% risk for...Arizona News
The Center for Medicare and Medicaid Innovation (Innovation Center) announced the provisional acceptance of 110 Accountable Care Organizations (ACOs) applications to the ACO REACH model. We have identified seven ACOs that made the provisional list to operate in Arizona. Four REACH ACOs are already operating in the state as part of the...
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...
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...
