An important feature of the health reform legislation passed in March 2010 is a provision that enables Medicare to reward health care organizations that meet quality-of-care and cost-reduction goals with a share of the savings that result. To participate in the program, health care providers must organize themselves into accountable care organizations (ACOs)—a term used…
Accountable care organizations in the Medicare Shared Savings Program (MSSP) have saved Medicare $2.7 billion to date, including $859 million in 2016, according to a new analysis from the National Association of ACOs (NAACOS). The latest financial data outpaces calculations by the Centers for Medicare & Medicaid Services (CMS) which says ACOs saved $1.6 billion…
Intense debates on every subject are constantly swirling in the healthcare policy sphere; that has always been the case. But one debate that is both impactful and being closely watched is the intensifying argument between the Centers for Medicare and Medicaid Services, particularly CMS Administrator Seema Verma, and some leader organizations in the accountable care…
It is a great time to monitor healthcare transformations from close quarters. It is also interesting to notice how healthcare has become a battleground for all sorts of experimentations and evaluations in recent times. We have AI chipping in from one end and blockchain from another. We have a booming wearables market along with a…
People with complex care needs account for nearly one-fifth of all health care spending, even though they comprise only 1 percent of patients. These are individuals with multiple chronic conditions or functional limitations; people whose conditions carry significant nonmedical needs; and frail older adults. Their mental health, physical health, and social needs require coordination across numerous…
Social determinants hold the potential improve care, reduce costs and enhance the lives of individuals, but so far the business and financial incentives haven’t existed for putting them to widespread use. With the transition to value-based care and population health programs, however, social determinants are on the verge of becoming more mainstream. But that will…
When the Centers for Medicare & Medicaid Services (CMS) released its proposals to overhaul the federal Medicare Shared Savings Program (MSSP), it was expected that industry associations, along with the ACOs (accountable care organizations) themselves, would push back strongly. After all, in the August proposed rule, CMS, which has the core aim to push these…
Low-income and rural patients are least likely to access healthcare services delivered remotely via video, phone call or text message, according to a study published in Health Affairs. Researchers from George Washington University in Washington, D.C., reviewed four years of data from a survey commissioned by the Association of American Medical Colleges to assess trends…
“Provider Payment Reform: Right Course, Wrong Students?,” a recent blog post authored by Chris Koller, President of the Milbank Memorial Fund, argues that while delivering high-value care to vulnerable populations is the “right coursework” for the US health care system, the “courses” (value-based payment (VBP) programs) should be targeted toward primary care practices, as opposed…
For the past 30 years, I’ve been deeply entrenched in healthcare and have had the great fortune of holding positions across the entire care continuum. Suffice it to say, the continuum most patients experience is far from perfect. How do we each use our sphere of influence to begin to improve outcomes throughout the healthcare…
In the state of New York alone, patients being discharged from hospitals into a post-acute care (PAC) settings can choose from more than 620 nursing homes, 120 certified home health agencies and 1,400 licensed home care services agencies. A similar breadth of PAC options exist in many other U.S. markets as well. The emergence of accountable care…
Personal attitudes inform our strategies for improving patient health. As ACOs move forward in Value-Based Health Care, attitudes about patients and providers set the stage for collaboration or conflict. And with ACOs taking on financial risk for patients, those attitudes and strategies can make the difference between success and failure. As we discussed in a…
