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“Push-Pull” For Providers In Medicare’s Proposed 2021 Rule For Physician Fees And Quality Reporting

The newly published 2021 CMS Physician Fee Schedule and Quality Payment Program (QPP) Proposed Rule reflects our harsh reality: Operate under the constraints of the COVID-19 pandemic, while moving toward uniformity and Risk. That tension is palpable in the Proposed Rule’s “push-pull” of CMS trying to continue to advance a Value agenda while stuck in the mud…

CMS Drops Proposed Rule Impacting Quality Payment Program, MSSP ACOs

The Centers for Medicare & Medicaid Services (CMS) on Aug. 3 released a rule that proposes changes to the Quality Payment Program (QPP) and Medicare Shared Savings Program (MSSP) for 2021. According to federal officials, because providers must stay focused on the COVID-19 pandemic, the number of significant proposed changes to the programs are limited….

MEDICARE Home-Based Medical Care Can Reduce Hospitalizations and Lower Costs — But It’s Still Underutilized

While home-based medical care has been shown to reduce hospitalization rates and lower costs for both homebound and non-homebound populations alike, it continues to be drastically underutilized in the current health care ecosystem. As a result, there are millions of older Americans — especially those living in rural areas — who are going without the…

Some Alternative Payment Models Are Improving Behavioral Health

Alternative payment models (APMs) are taking steps to improve behavioral health, but the models need more to make large strides, according to a study from the University of Washington and Harvard Medical School. The study from published in JAMA Network Open last week detailed the findings of a literature review on 17 APM implementations in mental health and substance…

COVID-19, Direct Contracting, & ACOs: Where Are We Headed?

Talk about down to the wire! On June 3, 2020, CMS finally decided to extend NextGen ACOs for another year. While the program was originally supposed to sunset at the end of 2020, CMS is providing some wiggle room to account for the impact of COVID-19. Given the recent significant increase in Coronavirus cases in…

Telehealth made up almost half of all Medicare beneficiaries’ primary care use in April

Dive Brief: Fee-for-service Medicare beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report. The report, released Tuesday by HHS’ Assistant Secretary for Planning and Evaluation, analyzed claims data from January through early June and found FFS Medicare beneficiaries’ use of in-person primary care fell sharply mid-March, while…

RECORDED WEBINAR: How to Achieve Success in your ACO Using Consulting and Technology to Your Benefit

 Join Salient Healthcare and Pinnacle Healthcare Consulting to explore how the intersection of consulting and technology can move an Accountable Care Organization forward. Topics to be covered: Why the current climate is making it hard for ACOs to survive How consulting services can make a significant impact on lowering costs The role of technology…

A New Study Proves It: Complex Care Management Makes All the Difference

Often in healthcare, it’s very important to be able to document information and insights that experts and leaders already knew before the research was done. That certainly seems to apply in this instance, in which a study has been published in the July issue of the American Journal of Managed Care that confirms that complex care management…

Leapfrog Group: Employers rank Cigna highest, UnitedHealthcare lowest on drive for value

U.S. employers ranked Cigna the highest and UnitedHealthcare the lowest for its efforts to drive value-based healthcare, according to a new survey from The Leapfrog Group. For its survey, Leapfrog asked executives that administer and fund benefits for its workforce to rate their plan on responsiveness to employer priorities, transparency, payment reform and value strategy. More than…

Researchers: Next Gen ACOs Doing Complex Care Management Are Reducing Hospitalizations, Costs

The care management provided by accountable care organizations (ACOs) participating in Medicare’s Next Generation ACO program is proving highly effective, according to a study published in the July issue of the American Journal of Managed Care (AJMC), with care management resulting in a 21-percent reduction in hospitalizations and a 22-percent reduction in costs. The article, entitled “Effective…

Episodes Are More Than Payment Models: They’re Key To Improving Care

For many health systems and groups, episodes are esoteric. Providers often think of them only in context of risk-based payment models like bundled payments and capitation. Navigating Value-Based Health Care contracts, providers analyze and model performance under Fee-for-Service and episode-based payments to decide their course of action. Or, if already in Value-Based reimbursement, they use them as…

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