Value-based care and reimbursement
The healthcare industry is transitioning from the traditional fee-for-service system to reimbursement structures that tie payment to quality and cost of care. Value-based care and reimbursement aim to improve patient outcomes and reduce healthcare spending while improving the experience for patients and clinicians.
Top Stories
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News
14 Nov 2024
Back surgeries: Low-value care swells Medicare spending
According to new research from the Lown Institute, unnecessary back surgeries led to an estimated $2 billion in Medicare spending over a three-year period. Continue Reading
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30 Oct 2024
Medicare Shared Savings Program saves $2.1 billion in 2023
Accountable care organizations in the Medicare Shared Savings Program earned performance payments totaling $3.1 billion in 2023, the highest since the program's establishment. Continue Reading
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12 Jul 2022
Opportunities, Challenges of Value-Based Care Adoption
Mount Sinai Health System is leading the value-based care adoption charge, but CEO Kenneth Davis says data is still missing to propel the entire industry forward. Continue Reading
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07 Jul 2022
Local Post-Acute Care Resources Tied to Hospital Readmissions, Pay
A new study found that hospital readmission rates were lower when hospitals could access a larger local supply of primary care physicians, SNF beds, and nursing home beds. Continue Reading
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06 Jul 2022
CMS Analysis Reveals Implicit Bias in Healthcare, Value-Based Payment
An analysis of three CMS Innovation Center models found instances of implicit bias in healthcare, which led to the exclusion of beneficiaries from some value-based payment models. Continue Reading
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28 Jun 2022
HHS Unveils New Alternative Payment Model for Cancer Care
The alternative payment model stems from President Biden’s reignited Cancer Moonshot initiative and aims to incentivize providers to treat the whole patient, not just a patient’s cancer. Continue Reading
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20 Jun 2022
Specialty-Oriented ACO Improved Outcomes, Spending for ESRD Patients
Individuals aligned with the specialty-oriented ACO focused on ESRD saw a spending reduction of $126 per beneficiary per month during the first year. Continue Reading
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14 Jun 2022
AHA Recommends Changes to Radiation Oncology Model Following Delay
AHA noted concerns about the discount factors, stop-loss policies, and quality measures included in the Radiation Oncology model. Continue Reading
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27 May 2022
Home Healthcare Providers Share Thoughts on Value-Based Care
Home healthcare providers reported that better client outcomes and increased patient satisfaction were among the top benefits of value-based care. Continue Reading
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24 May 2022
Shared Financial Risk Lowered Healthcare Costs for CA Residents
Shared financial risk between providers and payers was associated with lower out-of-pocket costs for patients and reduced pharmacy prices for providers. Continue Reading
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17 May 2022
Efficient Data Sharing Needed for Value-Based Care Transition
For healthcare organizations to successfully transition to value-based care, data sharing methods between providers and payers must be faster, more transparent, and done with trust. Continue Reading
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12 May 2022
Challenges, Trends Among ACO Home-Based Care Initiatives
Nearly 40 percent of ACOs with home-based care initiatives said they would consider expanding their services only if the program demonstrated a positive return on investment. Continue Reading
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02 May 2022
Advanced Bundled Payment Model Reduced Medicare Episode Payments
The BPCI Advanced Model reduced Medicare episode payments but resulted in a $65 million net loss for Medicare after achieving savings for surgical episodes but leading to a loss for medical episodes. Continue Reading
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28 Apr 2022
Shared Savings in Value-Based Payment Models Produce More Incentives
With no health insurance churn, value-based payment models that offer clinicians a portion of expected future shared savings could improve postpartum preventive services. Continue Reading
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26 Apr 2022
CMS Plans to Reweight 2021 MIPS Cost Performance Category
Due to the ongoing impacts of the COVID-19 pandemic, the agency will change the MIPS cost performance category weight from 20 percent to 0 percent for the 2021 performance year. Continue Reading
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23 Mar 2022
Healthcare Merger Aims to Advance Value-Based Kidney Care
Fresenius Health Partners, InterWell Health, and Cricket Health plan to form one organization, leveraging predictive analytics and a substantial network of nephrologists to advance value-based kidney care services. Continue Reading
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22 Mar 2022
Value-Based Payment Models Associated with Lower Acute Care Use
Medicare Advantage beneficiaries who received care under value-based payment models, including two-sided risk models, saw lower acute care use than beneficiaries under a fee-for-service model. Continue Reading
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21 Mar 2022
Stratifying Hospital Readmissions Reduction Program Improved Equity
After CMS implemented a stratification process, safety-net hospitals received reduced penalties in the Hospital Readmissions Reduction Program. Continue Reading
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10 Mar 2022
Organizations Urge CMS, HHS to Terminate New ACO REACH Model
Despite the attempt to redesign the controversial payment model, organizations are again calling on CMS and HHS to cancel the ACO REACH model that will replace the Direct Contracting model. Continue Reading
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03 Mar 2022
NAACOS Launches Coalition for ACO REACH Model Participants
The ACO REACH Model Coalition will provide resources and information about the new value-based payment model to interested and prospective participants. Continue Reading
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Feature
02 Mar 2022
What Is Value-Based Care, What It Means for Providers?
Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity. Continue Reading
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01 Mar 2022
Collective Reform Program Participation Did Not Improve Health Outcomes
Single participation in delivery system or payment reform programs led to better performance measures in primary care delivery, compared to collective participation in three programs. Continue Reading
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25 Feb 2022
CMS Replaces Direct Contracting Model with New ACO REACH Model
After receiving feedback from stakeholders, the agency has redesigned the Direct Contracting model and will launch the ACO REACH model that prioritizes provider-led participants and aims to advance health equity. Continue Reading
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24 Feb 2022
Former Obama Appointees Urge HHS, CMS to Continue Direct Contracting
The letter stated that the Direct Contracting model helps further value-based payment models and encourages ACOs to improve care coordination for Medicare beneficiaries. Continue Reading
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16 Feb 2022
NAACOS, APG Urge HHS to Adjust Direct Contracting Model, Not Cancel
The organizations suggested that HHS limit entity participation, add more beneficiary protections, and change the name of the Direct Contracting model instead of eliminating the program. Continue Reading
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15 Feb 2022
Signify Health to Acquire Caravan Health, Further Value-Based Care
The acquisition will help promote value-based care and establish a significant network of providers involved in risk-based payment models. Continue Reading
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07 Feb 2022
764 Hospitals Face Value-Based Penalties Under HAC Reduction Program
Hospitals that fall in the lowest-performing quartile of the HAC Reduction Program will receive value-based penalties and lose 1 percent of their Medicare reimbursement. Continue Reading
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04 Feb 2022
NAACOS, AMA Urge Congress to Boost Value-Based Care, APM Incentives
The groups urged Congress to promote value-based care and alternative payment model adoption by expanding program participation incentives. Continue Reading
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01 Feb 2022
Physician Compensation Still Hinges on Volume at System-Owned Practices
Increasing volume of services was the most commonly reported action to increase physician compensation at health system-owned practices, a new study shows. Continue Reading
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27 Jan 2022
More Beneficiaries, But Fewer ACOs for Medicare Shared Savings Program
New Medicare Shared Savings Program data for 2022 shows that ACO participation has plateaued while the number of beneficiaries cared for by ACOs grew modestly. Continue Reading
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17 Jan 2022
Over 50 Lawmakers Urge Administration to End Direct Contracting
The lawmakers claim direct contracting is a Trump-era privatization tactic that has removed millions of seniors from Traditional Medicare without their knowledge or consent. Continue Reading
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Answer
22 Dec 2021
The State of Value-Based Reimbursement, Financial Risk in Healthcare
New data from LAN shows modest progress with value-based reimbursement adoption in 2019 and 2020. But some programs, like Medicare Advantage, are moving to financial risk faster than others. Continue Reading
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News
09 Dec 2021
Study Finds Low-Value Services Increases Risk for Direct Harm
The analysis revealed 50 percent of identified low-value services were found to have direct harm potential. Continue Reading
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Feature
02 Dec 2021
Why Rural Providers Aren’t Transitioning to Alternative Payment Models
A smaller percentage of rural providers are participating in Advanced Alternative Payment Models because of a lack of capital and data analysis capabilities, GAO reports. Continue Reading
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30 Nov 2021
CMS Axes Primary Care First Model’s Seriously Ill Population Component
The agency will no longer move forward with the Seriously Ill Population Component of the Primary Care First Model, an alternative payment model run by the Innovation Center. Continue Reading
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29 Nov 2021
How Providence Is Overcoming a Top Value-Based Care Challenge
Value-based care arrangements are gaining traction, but a lack of information on patients outside of Providence St. Joseph’s system has been a major challenge. Continue Reading
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29 Nov 2021
Supply Chain, Labor Inflation Poses Risk to Healthcare Profit Margins
Healthcare profit margins are at risk due to labor inflation and supply chain disruption, Fitch Ratings reports. Continue Reading
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18 Nov 2021
APM Adoption Slows as Price Transparency Capabilities Heat Up
The latest CHIME Digital Health Most Wired survey shows that APM adoption recently slowed as providers prioritized price transparency capabilities, like estimating costs. Continue Reading
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17 Nov 2021
Health Systems Set Sights on Risk-Based Payment in Medicare Advantage
Over half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. Continue Reading
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08 Nov 2021
Study: Consecutive Penalties for Preventable Hospital Readmissions
A handful of hospitals have faced consecutive annual Medicare reimbursement reductions due to high rates of preventable hospital readmissions. Continue Reading
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25 Oct 2021
62% of Consumers Unfamiliar with Value-Based Care, Study Finds
Consumers could benefit from increased communication about value-based care from their providers and payers, with only one in four familiar with the term, a new study found. Continue Reading
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21 Oct 2021
Next Generation ACO Model Has Saved Medicare $667M, So Far
The Next Generation ACO Model has resulted in gross Medicare savings over four years. However, shared savings and other payouts have led to net losses with one more year to go. Continue Reading
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21 Oct 2021
CMS Lays Out New Strategy for Advancing Value-Based Care, APMs
CMS now expects all traditional Medicare beneficiaries to be treated by a provider in value-based care model by 2030. CMMI plans to achieve this through five new strategic objectives. Continue Reading
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20 Oct 2021
Allow ACOs to Use Pre-Pandemic Years for 2022 Benchmarks, Groups Urge
NAACOS and 11 other healthcare groups penned a letter to CMS urging them to let ACOs use pre-pandemic years to set MSSP benchmarks for 2022. Continue Reading
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20 Oct 2021
What It Takes for Medicare ACOs to Earn Shared Savings
A new analysis of Medicare ACO performance data shows what characteristics are shared by those earning shared savings last year. Continue Reading
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15 Oct 2021
Key Characteristics for Successful Downside Risk Contracting
KLAS and population health management vendors evaluate health organizations in adopting downside risk contracting. Continue Reading
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07 Oct 2021
Value-Based Payment Models May Help Hospitals Prepare for Surges
Hospitals may better prepare for peak season and pandemic-related demand surges by transitioning to value-based payment models. Continue Reading
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06 Oct 2021
Top Challenges of the Merit-Based Incentive Payment System
GAO found that providers faced challenges during their participation in the Merit-Based Incentive Payment System, including untimely feedback and low return on investment. Continue Reading
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30 Sep 2021
Surgical Costs, Complications Slowed Under MD’s All-Payer Model
A new study indicates that Maryland’s all-payer model, which caps hospital spending and avoidable complications, works for surgical procedures. Continue Reading
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29 Sep 2021
Lessons Learned from Aetna, Cleveland Clinic’s Joint ACO Model
Leaders from Aetna and Cleveland Clinic reflect on the first year of their joint ACO and health plan and share how others can deliver value-based care to their local markets. Continue Reading
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21 Sep 2021
How Morgan Health is Paving the Way for Advanced Primary Care
Morgan Health, the healthcare venture from JPMorgan Chase, is reforming healthcare payments and hoping to improve quality through advanced primary care for some of its employees. Continue Reading
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16 Sep 2021
Lack of Healthcare Interoperability Hinders Electronic ACO Reporting
CMS should not mandate electronic ACO reporting until true healthcare interoperability is achieved, ACOs recently told the agency. Continue Reading
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02 Sep 2021
10 ACOs with the Highest Shared Savings Payments in 2020
Despite a pandemic, 2020 demonstrated the fortitude of accountable care organizations (ACOs), with these ten making the most of shared savings payments. Continue Reading
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26 Aug 2021
Medicare ACO Savings Increased to $4.1B in 2020
The total Medicare ACO savings made it the best year yet for the Shared Savings Program, according to NAACOS, which also reported high quality scores in 2020. Continue Reading
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16 Aug 2021
Value-Based Care Assessment: The First Step to Value-Based Care
Taking the first step to value-based care can be the hardest for organizations trapped in a fee-for-service world. A value-based care assessment is helping one hospital prepare to start its journey. Continue Reading
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12 Aug 2021
Hybrid Primary Care Payment Structure Crucial to Quality Care
Patient-centered care and a new hybrid primary care payment system are critical to ensuring quality patient care, researchers say. Continue Reading
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09 Aug 2021
MIPS Quality Score Not Often Associated with Better Patient Outcomes
An analysis of MIPS quality scores found little correlation between MIPS measures, better patient outcomes, and lower rates of postoperative complications. Continue Reading
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06 Aug 2021
For-Profit Hospitals Use Conveners for Bundled Payment Success
Non-teaching and for-profit hospitals are more likely to use conveners for bundled payment success and those that use conveners tend to choose more episodes and those with higher target prices. Continue Reading
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16 Jul 2021
Telemedicine Use Higher Among PCPs with Value-Based Payment
A study of Medicare Advantage enrollees during the COVID-19 pandemic found that telemedicine use soared among primary care practices with value-based payment models. Continue Reading
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06 Jul 2021
AMGA to CMS: Rethink ACO Financial Risk Advancement in MSSP
AMGA expressed some concerns following CMS’ decision to extend its postponement policy regarding ACO financial risk advancement in the Medicare Shared Savings Program. Continue Reading
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30 Jun 2021
Patient-Centered Alternative Payment Models Needed for Success
In order to achieve alternative payment models that improve care quality and yield lower costs, payers need to implement patient-centered models designed by physicians. Continue Reading
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25 Jun 2021
Social Determinants Are Associated with Increased Medicare Spending
A new study shows how high measures of social determinants of health correlate with geographic variation and increased Medicare spending. Continue Reading
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22 Jun 2021
Number of Accountable Care Organizations Declined During COVID-19
There were fewer public and private accountable care organizations by Q1 2021, continuing a trend stemming from higher downside risk introduced in 2019. Continue Reading
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17 Jun 2021
MedPAC to HHS: Reduce Number of Alternative Payment Models
A “more harmonized portfolio of fewer alternative payment models” would address the unintended consequences of model overlap, the advisory group reports. Continue Reading
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11 Jun 2021
NIH Awards Grant to Study Effects of ACOs on Child Asthma Care
A UMass Amherst researcher received a $3M grant from the National Institutes of Health to study the effects of ACOs on childhood asthma care. Continue Reading
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08 Jun 2021
“Soft” Consolidation in Medicare ACOs Can Lead to Higher Prices
A new study found sudden, large price increases among some independent primary care practices that joined health system-led Medicare ACOs. Continue Reading
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03 Jun 2021
CJR Model Linked to Increased Health Disparities, Study Reveals
A new study reveals that Medicare’s Comprehensive Care for Joint Replacement model may be associated with increasing socioeconomic and racial health disparities. Continue Reading
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Answer
01 Jun 2021
Value-Based Contracting 101: Preparing, Negotiating, and Succeeding
The healthcare industry is increasingly engaging in value-based contracting; here are keys to success with these more complex payment arrangements. Continue Reading
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27 May 2021
Community Health Workers Help to Drop Hospital Readmission Rates
Clinical trial results revealed that hospital readmissions are less likely when patients are paired with community health workers, suggesting a new strategy for reducing ACO spending. Continue Reading
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26 May 2021
Spike in Radiologist Accountable Care Organization Participation
Radiologist participation in Medicare Shared Savings Program accountable care organizations is steadily increasing as value-based care popularity rises. Continue Reading
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25 May 2021
CMS to Reweight MIPS Cost Performance Category for 2020
CMS will reweight the MIPS cost performance category due to a lack of reliable data and the impact of COVID-19. Continue Reading
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25 May 2021
Remote Patient Monitoring, Telehealth Support Value-Based Contracts
More providers are standing up remote patient monitoring and other telehealth services in response to COVID-19 waivers. But the programs can be key to value-based contract success. Continue Reading
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24 May 2021
No Extension for Next Generation ACO Model After This Year
The Next Generation ACO Model will come to an end on Dec. 31, 2021, as planned after CMS found no net savings to Medicare during the model’s run. Continue Reading
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18 May 2021
Healthcare Payment Reform is Critical to Improving Primary Care
When it comes to primary care, moving from a fee-for-service payment model to hybrid, value-based care will be crucial to healthcare payment reform. Continue Reading
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14 May 2021
What Drives Value in the Merit-Based Incentive Payment System?
A survey reveals physician perspectives on the value drivers within the four components of the Merit-based Incentive Payment System, showing an emphasis on process improvement activities. Continue Reading
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13 May 2021
Medical Groups Ask for More Time Before ACO Quality Reporting Changes
Nearly a dozen medical groups have asked HHS Secretary Becerra to walk back changes to ACO quality reporting in the Medicare Shared Savings Program. Continue Reading
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07 May 2021
Home Discharge Program Prevents Hospital Readmission For ED Patients
The discharge service shortened hospital stays and prevented hospital readmission by providing emergency department patients with support at home. Continue Reading
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30 Apr 2021
Medicare FFS Claims Suggest Targeted Low-Value Care Interventions
Low-value services were delivered most often in southern non-teaching, for-profit hospitals among Medicare fee-for-service beneficiaries. Continue Reading
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26 Apr 2021
Providers Want Another Shot at Applying for Direct Contracting
Physician and hospital groups are urging CMS to reopen applications for the Global and Professional Direct Contracting Model after the agency closed the cycle early. Continue Reading
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20 Apr 2021
How Fowler Plans to Refresh CMMI’s Value-Based Care Vision
Ten years after the ACA created CMMI, newly minted head Liz Fowler plans to leverage lessons learned to emphasize system transformation and health equity. Continue Reading
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16 Apr 2021
Industry Groups Seek Next Gen Extension, Full-Risk ACO Options
Leading healthcare industry groups urged HHS to extend the Next Generation ACO Model through 2022 and provide a similar full-risk ACO option in the future. Continue Reading
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12 Apr 2021
CMS Stops Accepting New Direct Contracting Applications
Organizations that previously applied to the Global and Professional Direct Contracting Model and deferred will still be able to participate as planned. Continue Reading
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31 Mar 2021
CMS Delays CHART Model’s ACO Transformation Track
The request for applications release date has been delayed by a year to spring 2022 for the CHART Model’s ACO Transformation Track, while the Community Track continues as planned. Continue Reading
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29 Mar 2021
Solving the ACO’s Out-of-Network Utilization Problem
Technology is now driving physician referrals at one of the top Next Generation ACOs, reducing out-of-network utilization and driving better patient outcomes even during the pandemic. Continue Reading
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25 Mar 2021
NAACOS Calls For Renewed HHS Focus, Funding on Value-Based Care
To bring value-based care to the forefront, the association wrote to the HHS, calling for funding and policies that would promote ACO growth. Continue Reading
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19 Mar 2021
CMS Starts Primary Care First Value-Based Payment Model Second Wave
CMS has announced that it is now accepting applications for cohort two of the Medicare Primary Care First value-based payment model. Continue Reading
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16 Mar 2021
CMS Announces 184 Participants For ET3 Model, New Funding
The agency shared the final list of participants approved for the new ambulance provider APM as well as a $34M funding opportunity for states to expand emergency medical triage services. Continue Reading
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16 Mar 2021
Risk Stratification Of Bundled Payment Models Requires Clinical Data
Lack of clinical data analysis in the development of CMS’ metastatic risk adjuster may lead to skewed bundle payments for oncological care. Continue Reading
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10 Mar 2021
Biden Administration Pauses Key Value-Based Reimbursement Models
The administration is reviewing Direct Contracting and Primary Care First options and pushing back timelines for other major value-based reimbursement models, including the MSSP. Continue Reading
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04 Mar 2021
Preparing Physician Practices for Direct Contracting, Risk Models
Collaborative Health Systems is preparing some of its physician practice partners for Directing Contracting using technology and workflow. Continue Reading
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04 Mar 2021
Hospital Risk Stratification Leads To Equitable Value-Based Payment
Social risk stratification reduced value-based penalties among safety-net hospitals, allowing for a more equitable measure of care quality. Continue Reading
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01 Mar 2021
CMS: Automatic Exception for MIPS Eligible Clinicians in 2020
CMS will automatically apply the extreme and uncontrollable circumstances policies to all MIPS eligible clinicians for the 2020 performance period because of COVID-19. Continue Reading
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17 Feb 2021
Addressing Social Determinants Lowered ED Utilization in Medicare
The Accountable Health Communities Model cut ED utilization by 9% among Medicare FFS beneficiaries, indicating the success of models addressing social determinants of health. Continue Reading
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17 Feb 2021
Low-Value Care Spending Slows as Medicare Pushes Value-Based Care
Medicare spending increased on opioids and antibiotics, however low-value care spending has marginally decreased as value-based care is slowly adopted. Continue Reading
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Feature
16 Feb 2021
What are Capitation Reimbursement Models, Key Strategies?
As value-based care becomes more popular, capitation reimbursement models could help ensure care delivery is based on quality, not quantity. Continue Reading
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09 Feb 2021
Physician Practices Trail Hospitals in Value-Based Care Readiness
Large provider organizations, such as hospitals and health systems, are better equipped for value-based care than small and non-affiliated provider groups, according to Insights’ Value-based Care Assessment. Continue Reading
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25 Jan 2021
ACO Participation Hits New Low as Biden Administration Takes Over
ACO participation has dropped to 477 in the Medicare Shared Savings Program in 2021, the lowest number since 2016. Continue Reading
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14 Jan 2021
Next Generation ACOs Saved Medicare $558M in 2019
Partial 2019 performance data shows that Next Generation ACOs saved Medicare money while hitting an average quality score of about 94%. Continue Reading
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12 Jan 2021
CMS to Expand Home Health Value-Based Purchasing Model
The Home Health Value-Based Purchasing Model has improved quality scores by 4.6% and saved Medicare about $141M annually, the agency reports. Continue Reading
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07 Jan 2021
Fee-For-Service Payments Still an Issue in VT All-Payer ACO Model
Paying for value in a fee-for-service payment world is creating challenges for providers in Vermont’s innovative All-Payer ACO Model, spelling trouble for the model’s expansion. Continue Reading
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23 Dec 2020
ACOs Fear Direct Contracting Options Stray Too Far From Providers
CMS designed direct contracting options to attract a broad range of organizations, including MCOs, but now ACOs are saying they may disenfranchise value-based providers. Continue Reading
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08 Dec 2020
Making Data Sharing A Condition in Value-Based Contracts
Data sharing is critical to delivering value, so Summit CityMD ensures it is a condition when negotiating value-based contracts with payers. Continue Reading