CMS has been quietly reviewing several of its payment models to decide if they will be implemented. Below is a list of updates CMS has released about its payment models: 1. Primary Care First CMS is reviewing the Primary Care First payment model’s seriously ill population component. The payment model component was slated to start April 1,…
Hu founded CarePort while she was a graduate student at Harvard. The care coordination technology company was acquired a second time last fall by Wellsky, a healthcare technology company for $1.35 billion. Senior Editor Peter Wehrwein spoke with Hu about the new CMS Direct Contracting Model, the latest addition to the value-based care menagerie, and what it…
The Centers for Medicare and Medicaid Services (CMS) has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase quality of care. As the healthcare industry moves toward value-based care delivery, the PCF model will explore if switching from fee-for-service to Medicare performance-based payments could…
When CMS first announced new primary care payment models in April 2019, ACOs understood that their future might be threatened by competition for both physicians and patients. If medical groups could independently contract with Medicare under these models, they would have the advantage of greater control over their physician network, referral arrangements, and clinical decisions….
Health insurers often pay health plans to manage the care of their members. Good care can help prevent emergencies, such as avoidable trips to a hospital emergency department (ED). Medically complex patients, such as those with behavioral health problems or substance use disorders, tend to have a lot of ED visits. Social determinants of health…
The pandemic has brought many hospitals and insurers both closer together or farther apart depending on how the two responded and interacted during the first year of the crisis. Providers and payers that expanded their cooperative efforts since COVID-19 struck are likely to continue on that path, and so are those who pulled back from…
Researchers at the University of Pennsylvania recently published a white paper that proposes a roadmap for value-based care over the next decade. On March 12, the co-authors gathered virtually to discuss lessons learned over the last decade and their five key recommendations, which include aligning alternative payment models (APMs) across all publicly financed healthcare and giving health equity a…
Abstract The COVID-19 pandemic threatens the health and well-being of older adults with multiple chronic conditions. To date, limited information exists about how Accountable Care Organizations (ACOs) are adapting to manage these patients. We surveyed 78 Medicare ACOs about their concerns for these patients during the pandemic and strategies they are employing to address them….
The Biden administration has paused several prominent value-based reimbursement models run by the CMS Innovation Center (CMMI) to review model details, according to several updates provided on model webpages. Among the value-based reimbursement models impacted are the Geographic Direct Contracting Model, Primary Care First Model’s Seriously Ill Population option, and the Kidney Care Choices Model—three…
Reforming our nation’s health care system is an economic and moral imperative that is long overdue. The COVID-19 pandemic has only further illustrated its deficiencies and made clear the vital importance of a high-value health system capable of responding to the needs of US citizens. While there have been meaningful improvements in healthcare delivery over…
