Providers and analysts are calling new value-based physician payment models announced last week by the CMS game-changers, potentially signaling a new era in which many providers are taking on downside risk and responsibility for total cost of care. The five new voluntary payment models, which are available under the Primary Care First heading through the CMS Center…
Just over half of accountable care organizations (ACOs) said they would consider leaving the Medicare Shared Savings Program (MSSP) if required to take on more downside risk, revealed a study published in Health Affairs. Thirty-two percent of ACOs said they are extremely or very likely to leave, and 19 percent believe they are moderately likely to leave. In…
Speaking at the National Association of Accountable Care Organizations (NAACOS) Spring 2019 Conference, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma stated that ACOs in the government’s new Pathways to Success program are gearing up to take on higher levels of financial risk. Verma gave an opening keynote speech on April 25 at…
The CMS Center for Medicare and Medicaid Innovation’s planned push for a regional population-based budget in traditional fee-for-service Medicare could launch a major transformation in curbing sprawling healthcare costs for the program. That’s the hope of the Trump administration’s top health officials. On Monday they opened the public comment period for five primary-care pay demonstrations. Their “population-based payment” demonstration—in…
In 2012, the Centers for Medicare and Medicaid Services (CMS) launched new voluntary payment models for Accountable Care Organizations (ACOs) with incentives to control spending. The number of Medicare ACOs has grown steadily to more than 600 organizations responsible for managing care for nearly 12 million Medicare beneficiaries in 2018. Similar programs have been established in the…
HHS on Monday launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk. HHS Secretary Alex Azar told a crowd of stakeholders at the American Medical Association in Washington that the CMS projects the new voluntary programs will…
Download Slides Covered in this session: Central data repository (HE Repository) for Medicare claims and clinical data. This process requires a clinical data integration plan for each clinic. Decide from the outset of the ACO start date if specialists will complete and/or report the quality measures. Assign every attributed patient to a provider using…
There are 41 accountable care organizations in the CMS’ Next Generation ACO Model for 2019, which represents a substantial decline from 2018 when 51 organizations were in the model. Data updated on CMS’ site this week shows that 12 ACOs that participated in 2018 have either left or were booted from the program for the 2019 performance…
The experimental phase of Medicare ACOs has been officially declared dead, per CMS. Going forward, ACOs must agree to take on financial risk for expenditures beyond their targets. That’s sobering news for the majority of ACOs still struggling to succeed. The reality is that most ACOs are bootstrapped—light on extra funding and dependent on existing tools…
Commercially insured members who were cared for by providers that shared financial risk with payers saw higher clinical quality and lower costs on average in 2017, according to benchmarking tool Atlas. The analysis is based on data from seven health plans that represent 7.2 million lives in California. That’s about 55 percent of the state’s entire…
