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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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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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
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03 Dec 2020
CMS Announces A New Value-Based Direct Contracting Model
The new regional model adds to a growing portfolio of direct contracting models, which test the “next evolution of risk-sharing arrangements,” according to CMS. Continue Reading
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01 Dec 2020
Payers, Providers Need Data to Talk Value-Based Care
Data analytics and sharing is key to advancing the care coordination needed to achieve value-based care in a post-pandemic world, according to industry experts. Continue Reading
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18 Nov 2020
ACOs, Population-Based APMs Most Effective at Lowering Costs
An assessment of over a dozen CMS initiatives over the past 8 years shows that population-based alternative payment models, like ACOs, saved Medicare the most money. Continue Reading
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12 Nov 2020
Key Considerations for Providers Thinking of Capitation Payments
Industry experts share 5 challenges providers may encounter when switching from fee-for-service to capitation payments. Continue Reading
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05 Nov 2020
51 Organizations Join New Direct Contracting Opportunity from CMS
The 51 participants, otherwise known as Direct Contract Entities, will take part in the model’s implementation year from Oct. 1, 2020, through March 31, 2021. Continue Reading
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04 Nov 2020
Most Facilities in Hospital Readmissions Reduction Program Penalized
82% of facilities part of the Hospital Readmissions Reduction Program in FY 2021 received a negative Medicare payment adjustment because of excessive readmissions, CMS data shows. Continue Reading
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02 Nov 2020
CMS Releases Initial Quality Payment Program Results for 2019
An overwhelming majority (97%) of eligible clinicians engaged with the Quality Payment Program, with 84% of them earning a positive payment adjustment for exceptional performance, CMS reports. Continue Reading
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02 Nov 2020
Transitioning to Value-Based Care While Reducing Risks
Even during COVID-19, healthcare organizations need to prepare for value-based care reimbursement. Continue Reading
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26 Oct 2020
CMS Pushes Back Launch of Radiation Oncology Model
The agency has decided to delay the launch of the Radiation Oncology Model to July 1, 2021, after receiving stakeholder feedback. Continue Reading
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14 Oct 2020
Designing Alternative Payment Models for Health System Resiliency
The COVID-19 pandemic has been the burning platform for alternative payment models that use population-based payments for whole-person care, industry experts are saying. Continue Reading
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02 Oct 2020
Top 10 Accountable Care Organizations by Shared Savings in 2019
Accountable care organizations in the Medicare Shared Savings Program had a record year in 2019; here are the ACOs that earned the highest bonuses. Continue Reading
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28 Sep 2020
Private Payers Outpace Public Insurance in Value-Based Care Push
New research from Insights by Xtelligent Healthcare media revealed private payers are more likely than their public counterparts to be participating in value-based reimbursement models. Continue Reading
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25 Sep 2020
How Top Accountable Care Organizations Save Year After Year
Accountable care organizations continually save on post-acute care and hospitalizations. But how the providers do that has evolved over the years, while new strategies have emerged. Continue Reading
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22 Sep 2020
Most ACOs Worried About Rising Advanced APM Thresholds Next Year
By failing to meet new Advanced APM thresholds, the ACOs will not receive the 5% incentive payment, which they say has been key to value-based care advancements. Continue Reading
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21 Sep 2020
CMS Finalizes Alternative Payment Models for Specialty Care
One alternative payment model targets end-stage renal disease, while the other is a bundled payment demonstration for 16 cancer types. Both will be mandatory in certain regions. Continue Reading
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17 Sep 2020
Multi-Payer Alignment Key to Advancing Value-Based Care in Medicaid
Medicaid value-based care efforts have been piecemeal for too long, CMS Administrator Verma said in a letter to Medicaid directors on the agency’s push for more APMS in the program. Continue Reading
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16 Sep 2020
Major Changes Coming to BPCI Advanced Clinical Episodes, Prices
In less than four months, CMS will implement new ways of setting target prices and selecting clinical episodes under the BPCI Advanced to prevent significant financial losses down the road. Continue Reading
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15 Sep 2020
Medicare Shared Savings Program Saved a Record $1.19B in 2019
CMS also reported that ACOs in the Medicare Shared Savings Program saved more under new Pathway to Success tracks and if they assumed downside risk. Continue Reading
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10 Sep 2020
Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS
A new study found that clinicians with high social-risk caseloads were 99% more likely to get penalized under MIPS and 52% less likely to earn an exceptional performance bonus. Continue Reading
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08 Sep 2020
Coronavirus Pandemic Impacts Value-Based Contracts
The COVID-19 public health crisis will push the industry further away from fee-for-service reimbursement and is currently impacting conversations about value-based contracts, according a recent report from Insights by Xtelligent Healthcare Media. Continue Reading
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20 Aug 2020
Healthcare Providers Did Not Take On More Financial Risk in 2019
A new report shows no change in the share of healthcare revenue at financial risk in 2019, with half of execs reporting 10% or less of revenue in risk-based contracts that year. Continue Reading
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13 Aug 2020
PCPs Paid Under Global Capitation Deliver Higher Quality Care
Primary care physicians paid global capitation payments hit key quality metrics at higher rates that those paid via fee-for-service, according to UnitedHealth Group. Continue Reading
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12 Aug 2020
CMS Unveils New Value-Based Care, ACO Options for Rural Providers
Under a new rural health model, CMS will provide funding to rural providers and their communities to build value-based care systems and encourage ACO participation. Continue Reading
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31 Jul 2020
Some Alternative Payment Models Are Improving Behavioral Health
Alternative payment models targeting behavioral health disorders were associated with process-of-care outcome improvements and spending reductions, but clinical outcome evidence is still missing, researchers find. Continue Reading
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20 Jul 2020
Value-Based Incentives Didn’t Reduce Hospital-Acquired Infections
Value-based incentive programs in Medicare did not improve hospital-acquired infection rates and may have disproportionately penalized safety-net hospitals, a recent study shows. Continue Reading
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17 Jul 2020
Banner Health Adopts Cerner’s Revenue Cycle Management Product
Cerner‘s revenue cycle management product is designed to streamline and simplify the clinician and patient experience across Banner Health’s system of hospitals and clinics. Continue Reading
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15 Jul 2020
Amazon Launches Health Centers to Boost Employee Access to Care
Through its collaboration with Crossover Health, Amazon will pilot convenient health centers near its fulfillment centers in Texas to ease access to care for its employees. Continue Reading
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14 Jul 2020
AMGA Calls for Medicare Shared Savings Program Changes Amid COVID-19
The association urged CMS to modify the Medicare Shared Savings Program to protect providers from increased costs during the pandemic and opposed the cancelation of the program’s 2021 application cycle. Continue Reading
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13 Jul 2020
Medicaid Alternative Payment Model Reduces Imaging, Costs
Paying community health centers a fixed monthly fee per patient under a Medicaid alternative payment model reduced services 42%, with most related to imaging, a new study shows. Continue Reading
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13 Jul 2020
Sound Advice: Transitioning to Value-Based Hospital Medicine
Leveraging hospitalists, identifying obstacles, and creating a clinical strategy are key strategies for transitioning to value-based hospital medicine. Continue Reading
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09 Jul 2020
Standalone ACOs Saved More Than Hybrid Medical Home Models
Standalone ACOs and patient-centered medical homes reduced healthcare costs more than the commonly adopted combination of the models, a new study found. Continue Reading
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01 Jul 2020
CMS Releases Initial Report on Risk-Based Bundled Payment Model
Early data from the Bundled Payments for Care Improvement Advanced model show promise for savings, but new research says episode design plays a bigger part in whether bundled payment models truly work. Continue Reading
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23 Jun 2020
CMS: Value-Based Reimbursement Key to Addressing Health Disparities
Value-based reimbursement encourages clinicians to care for the whole person, which is essential to addressing health disparities demonstrated by claims data from the COVID-19 crisis, CMS says. Continue Reading
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22 Jun 2020
How Value-Based Payments Support Physicians During a Crisis
Value-based payments support telehealth, data analytics, and other capabilities providers need to effectively respond to crises like COVID-19, says SWHR's Sanjay Doddamani, MD. Continue Reading
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18 Jun 2020
ACOs Can Grow Value-Based Payment in Medicare, But Changes Needed
The accountable care organization model would need to prevent patient selection to realize savings from value-based payments in the federal healthcare program, the Commission reports. Continue Reading
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16 Jun 2020
Coronavirus May Reshape Investment, Value-Based Reimbursement
The coronavirus pandemic will reshape where and how organizations invest moving forward, according to industry leaders at the Value-Based Care Summit | Telehealth20: Virtual Series. Continue Reading
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04 Jun 2020
CareMount’s Foundation for Accountable Care Organization Savings
Data analytics, care coordination, patient communication, and physician engagement were CareMount’s building blocks for success as a first-year Next Generation accountable care organization Continue Reading
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22 May 2020
More Physician Groups Lead Accountable Care Organizations
Physician groups are increasingly leading accountable care organizations, overtaking the number of hospital-led orgs by 2018. But this could signal a need for different policies, a new study shows. Continue Reading
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19 May 2020
ACOs Want Later Dropout Date for Medicare Shared Savings Program
In light of the coronavirus pandemic, ACOs should have until at least Oct. 31, 2020, to voluntarily exit the Medicare Shared Savings Program, nine industry groups said. Continue Reading
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18 May 2020
Providers in APMs Had Head Start with Managing COVID-19 Surge
A new survey shows that APM participants were more likely to leverage care management support for managing the COVID-19 surge, including triage call centers and remote patient monitoring. Continue Reading
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12 May 2020
ACO Participation Did Not Lower Care Access for Vulnerable Patients
A new study counters claims that ACO participation results in physician groups selecting fewer vulnerable patients, but downside risk adoption could change that. Continue Reading
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07 May 2020
Providers Say Cost Transparency Will Improve Value-Based Care
Collaboration for value-based contracting would be improved with increased cost transparency, providers reported in a recent Insights by Xtelligent Healthcare Media survey. Continue Reading
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21 Apr 2020
Clinicians to Earn MIPS Credit for Joining COVID-19 Clinical Trial
Eligible clinicians will be able to earn MIPS credit for participating in and reporting data on a COVID-19 clinical trial, CMS announced. Continue Reading
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14 Apr 2020
Over Half of At-Risk ACOs May Quit MSSP to Avoid COVID-19 Losses
As COVID-19 continues to upend care patterns and utilization, at-risk ACOs weigh exiting the MSSP and NextGen Model before they must repay CMS shared losses. Continue Reading
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06 Apr 2020
Home Hospital Reduces Costs, Readmission for Acutely Ill Patients
Home hospital care can reduce readmission rates and improve cost savings, according to a recent randomized controlled trial. Continue Reading
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26 Mar 2020
Healthcare Reimbursement Still Largely Fee-for-Service Driven
The healthcare industry is still heavily reliant on fee-for-service reimbursement despite a drive to adopt value-based care, according to Xtelligent Healthcare Media’s recent Value-Based Care Assessment. Continue Reading
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24 Mar 2020
CMS Relaxes Quality Reporting for Value-Based Purchasing Models
Due to COVID-19, the agency extended quality reporting deadlines for the MIPS, MSSP, and other key value-based purchasing programs for hospitals and post-acute care. Continue Reading
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18 Mar 2020
ACOs Concerned Coronavirus to Impact Shared Savings, Losses
The National Association of ACOs is calling on CMS to provide flexibilities for organizations in shared risk models in light of the novel coronavirus pandemic. Continue Reading
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11 Mar 2020
Third of Execs Don’t Think Value-Based Payment Will Usurp FFS
These execs believe the fee-for-service mindset is too entrenched, while others are looking to increase value-based payment through ACOs and bundles, a new survey shows. Continue Reading
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10 Mar 2020
High-Cost Utilization Persists Despite PCMH Implementation
Improvements from patient-centered medical home (PCMH) implementation were not associated with changes in ED visits or hospitalizations, a study shows. Continue Reading
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09 Mar 2020
Paving the Path to Success: Teaching Doctors Value-Based Care
Implementation of value-based care and payment has been slow and steady, but new educational initiatives could accelerate the transition. Continue Reading
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03 Mar 2020
Alternative Payment Models Save, But Drop-Out Rate Still a Concern
A review of alternative payment models shows savings and quality improvements, but high drop-out rates could mean downside risk is too much. Continue Reading
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28 Feb 2020
CMS Selects Participants for New Emergency Care Payment Model
The ET3 voluntary five-year payment model will test payments with the hopes to enhance Medicare beneficiaries’ access to emergency services when needed. Continue Reading
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27 Feb 2020
85% of Health Facilities Use Locum Tenens To Fill Care Gaps
85% of healthcare workforce management said they used locum tenens physicians during the last 12 months to fill gaps caused by physician shortages. Continue Reading
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25 Feb 2020
ACOs Need More Info on New Direct Contracting Model
NAACOS is urging CMS to release more information on payments, quality adjustments, and other aspects of the Direct Contracting Model as the application cycle closes. Continue Reading
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21 Feb 2020
2019 Single Worst Year for Rural Hospital Closures, Report Finds
19 rural hospital closures occurred in 2019 and the circumstances could get worse with over 450 rural hospitals vulnerable to closure, the report shows. Continue Reading
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19 Feb 2020
Out-of-Network Primary Care Linked to Higher ACO Costs
Primary care services outside of accountable care organizations’ networks are associated with increased costs, according to a new study. Continue Reading
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17 Feb 2020
The Role of the Accountable Care Organization in Value-Based Care
Accountable care organizations were developed to push the healthcare industry toward value-based care. But the model is not the final solution, industry experts say. Continue Reading
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14 Feb 2020
4 Key Strategies for Accountable Care Organization Success
Accountable care organizations play a critical role moving the care continuum toward value. But such complex contracting options make it challenging for ACOs to achieve success. Continue Reading
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12 Feb 2020
Providers Lagging with Value-Based Care, Consumer Strategy
Compared to payers, providers are further behind the value-based care and healthcare consumerism continuum, a new survey shows. Continue Reading
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10 Feb 2020
Advanced Primary Care Promotes Value-Based Care
Implementing advanced primary care models in a fee-for-service world is nearly impossible. A shift towards more holistic, patient-centered primary care requires health systems move towards value-based contracts. Continue Reading
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07 Feb 2020
Physicians Propose 5 Quality Measures to Improve Medical Billing
Proposed metrics of billing quality aim to tackle healthcare price transparency and reduce out-of-pocket costs in order to shift to patient-centered care. Continue Reading
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06 Feb 2020
Commercial Payer Spent $5.5B on Low-Value Care Services
The study also found low-value care was worse in some states, but states with the lowest rates still had nearly 10% of members who received at least one low-value care service. Continue Reading
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06 Feb 2020
New List of Essential Drugs Shows Hospital Supply Chain Fragility
Vizient recently identified 200 essential drugs which, if not available, would threaten the hospital supply chain and quality of patient care. Continue Reading
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05 Feb 2020
Practices in Oncology Care Model Ready to Assume Two-Sided Risk
Nearly 37% of practices in the Oncology Care Model chose to enter into two-sided risk, while 16% said they are dropping out, a survey shows. Continue Reading
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04 Feb 2020
AMGA: Advancing Value-Based Care Hinges on Claims Data Access
Improving claims data access for providers and patients topped the list of AMGA’s value-based care needs. Other demands included MACRA, ACO benchmarking, and physician self-referral reform. Continue Reading
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30 Jan 2020
How Social Media Helped an Accountable Care Organization Save $50M
Borrowing from Amazon, Facebook, and LinkedIn, an accountable care organization in Texas leveraged a HIPAA-compliant communications platform to improve care coordination. Continue Reading
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28 Jan 2020
ACOs Enrolled in MSSP Assume Downside Risk as the Program Matures
ACOs participating in MSSP have gradually assumed downside risk as the program progresses, seeing the greatest growth over the past three years. Continue Reading
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22 Jan 2020
What the Latest ACO Numbers Mean for the Future of the MSSP
With lower than average participation rates in 2020, ACO leaders expressed concerns for the viability of the Medicare Shared Savings Program (MSSP). Continue Reading
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17 Jan 2020
Entering the Next Phase of Value-Based Care, Payment Reform
The healthcare industry has learned a lot from the past 10 years of payment reform for value-based care. Experts explore what the future holds for alternative payment models. Continue Reading
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17 Jan 2020
CMMI Alternative Payment Models Won’t Save As Much as CBO Projects
The impact of CMMI’s alternative payment models on Medicare spending has not reached earlier projections by the CBO, Avalere reports. Continue Reading
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16 Jan 2020
High Quality Hospitals Treat Less Medicare Advantage Enrollees
Medicare Advantage enrollees had a significantly lower probability of being admitted to low and high quality hospitals than traditional Medicare enrollees, study finds. Continue Reading
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14 Jan 2020
Number of MSSP ACOs Taking Downside Risk Doubles, CMS Reports
Despite little change in participation, the number of MSSP ACOs taking downside risk increased from 93 ACOs in 2019 to 192 ACOs in 2020. Continue Reading
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13 Jan 2020
Next Generation ACOs Saved Medicare Over $184M in 2018
50 Next Generation ACOs saved Medicare in 2018 even after accounting for $285 million in shared savings payments and $64 million in shared losses, CMS reports. Continue Reading
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10 Jan 2020
Value-Based Care Consulting Firms Receive Top Marks from Providers
All value-based care consulting firms analyzed by KLAS scored above 85 out of 100 points, but the firms excelled within different scopes of engagement. Continue Reading
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06 Jan 2020
Advanced Alternative Payment Model Participation Rose in 2018
The number of eligible clinicians under MACRA participating in an Advanced Alternative Payment Model increased to 183,306 in 2018 from 99,076 the previous year. Continue Reading
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19 Dec 2019
Value-Based Care, Hospital Chargemasters Dominated 2019 Headlines
The top RevCycleIntelligence.com stories of 2019 touched on new trends, like price transparency and the opioid crisis, as well as tried-and-true topics, including value-based care and fraud prevention. Continue Reading
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18 Dec 2019
NAACOS Establishes Direct Contracting Taskforce
The Direct Contracting Taskforce is expected to help providers and other healthcare organizations take advantage of new government alternative payment models. Continue Reading
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16 Dec 2019
7 MI Providers Take on Shared Risk Payment Model with Blue Cross
A new shared-risk payment model will ensure health organizations have the correct tools to increase the quality of patient care. Continue Reading
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05 Dec 2019
Physician Compensation Programs Move Toward Value-Based Pay
The amount of physician compensation tied to value-based metrics increased across four major specialties from 2018 to 2019, a new report shows. Continue Reading
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27 Nov 2019
CMS Accepting Applications for New Direct Contracting Models
CMS recently released a request for applications that provided more details on Medicare’s Direct Contracting, which offer two voluntary value-based payment models. Continue Reading
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13 Nov 2019
Data, Clinical Champions Key to Risk-Based Payment Model Success
Internal and external data and having clinical champions to enact changes are critical to moving forward with risk-based payment models, say experts at the Value-Based Care Summit. Continue Reading
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23 Sep 2019
Reimbursement Adequacy, Timely Data Needed for Risk-Based Payment
Hospitals and health systems need better claims reimbursement and data access to put more of their population under risk-based payment models, Premier reported. Continue Reading
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16 Sep 2019
ACO Participation Dipped After Pathways to Success, NAACOS Finds
In 2019, ACO participation in the MSSP fell for the first time since the program launched in 2012, and less than half the number of new ACOs joined this year. Continue Reading
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11 Sep 2019
Verma Presses Hospitals to Assume Risk in Value-Based Care Models
Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. Continue Reading
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12 Aug 2019
Making APMs Truly Value-Based Through Person-Centered Care
Alternative payment models do not truly incent value-based care unless providers are accountable for delivering person-centered care, an industry expert says. Continue Reading
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18 Jul 2019
MSSP Sees Drop in New ACO Participation Under Pathways to Success
The Medicare Shared Savings Program welcomed 66 new ACOs under Pathways to Success, but nearly half of all participating ACOs assumed downside risk, CMS reports Continue Reading
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18 Jul 2019
Atrius Health Makes the Business Case for Risk-Based Payments
The Massachusetts-based medical group ended 2018 with a $38.7 million operating after tying 75% of its revenue to risk-based payments. Continue Reading
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10 Jun 2019
3 Strategies to Help Accountable Care Organizations Boost Savings
Managing the seriously ill population, establishing a home visit strategy, and leveraging health IT are key ways accountable care organizations can continue to save. Continue Reading
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03 Jun 2019
Accountable Care Organizations Lower Costs Compared to HMOs, PPOs
Commercial accountable care organizations in California had total costs of care of $4,405 in 2017, compared to $4,453 for HMOs and $4,601 PPOs, a new analysis finds. Continue Reading
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24 May 2019
How Downside Risk Will Impact Participation in Pathways to Success
ACOs must start weighing if the downside financial risk is worth the reward with the start of Pathways to Success pending. Continue Reading
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14 Mar 2019
How Accountable Care Organizations Can Prepare for Downside Risk
Fostering the right culture, implementing analytics, and improving care transitions will boost accountable care organization success with downside risk. Continue Reading
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25 Feb 2019
Preparing Providers for Value-Based Care, Consumerism in Healthcare
Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Continue Reading
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19 Sep 2018
Patient Attribution Key Component to APMs, Value-Based Contracts
Patient attribution defines a provider’s risk pool in alternative payment models and value-based contracts, and understanding the differences in attribution models is key, actuaries advised providers. Continue Reading
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15 Aug 2018
Academic Medical Centers Receive More Value-Based Penalties
A new study shows academic medical centers performed worse than their non-academic peers in value-based penalty programs and the centers had higher costs. Continue Reading
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16 Jul 2018
A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step
Geisinger Health Plan's CFO views a provider-sponsored health plan as a hospital's "natural next step," but providers need to think long-term with their plan to be successful. Continue Reading
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25 Jun 2018
How Addressing Social Determinants of Health Cuts Healthcare Costs
Nutrition programs, housing initiatives, and ridesharing partnerships are some of the ways providers are reducing healthcare costs by addressing social determinants of health. Continue Reading
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05 Mar 2018
72% of Medical Groups Oppose Mandatory Alternative Payment Models
Medical groups cited a lack of evidence, diversity among practices, and a negative impact on practice innovation as reasons for opposing mandatory alternative payment models. Continue Reading
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08 Jan 2018
3 Strategies to Reduce Hospital Readmission Rates, Costs
Identifying causes, enhancing transitional care, and engaging patients are three ways that hospitals can reduce hospital readmission rates and avoid penalties. Continue Reading