When asked why he robbed banks, Willie Sutton, the infamous US bank robber, responded “because that’s where the money is.” This quote is the inspiration for “Sutton’s Law,” which recommends prioritizing those diagnostic tests that are most likely to yield a definitive diagnosis and quickly lead to a treatment recommendation. While Sutton’s Law has been…
Download Slides Has your Medicare Shared Savings Program (MSSP) ACO taken full advantage of the many waivers of federal fraud and abuse laws, such as the Stark Law and the Anti-Kickback Statute? During the webinar we will discuss the different types of waivers, what they are, which ones matter to you, how to use…
Health care spending is projected to grow to 19.4 percent of gross domestic product (GDP) by 2027, and big gaps in quality and access to care persist. This has motivated payers and providers to implement alternative payment models (APMs) to enable higher-value care. There is bipartisan agreement, reflected in the Medicare Access and CHIP Reauthorization Act (MACRA)…
Executive Summary Alternative payment models (APMs) are central to the efforts to reduce the growth in healthcare costs and improve outcomes for patients. Yet some stakeholders remain skeptical of their potential. This is understandable, because APMs have shown mixed results. We have identified seven characteristics of well-designed models that yield meaningful savings for payers, improve…
The move to value-based care is not happening a year from now, or in a month, or even tomorrow. It’s happening as we speak. Why do I say that? An analysis from the Health Care Payment Learning & Action Network (HCP-LAN) in October 2018 revealed that 34% of healthcare dollars of 2017 flowed in from Alternative Payment…
The reason CMS Alternative Payment Models (APMs) are failing to significantly reduce spending in Medicare is that none of the major APMs meets the majority of the eight criteria for a successful APM. The Problems with Medicare’s Alternative Payment Models and How to Fix Them details the serious weaknesses in the six major Advanced APMs that have…
CMS issued a final rule Dec. 21 that makes sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven takeaways from the final rule: 1. There are currently four MSSP tracks. The final rule streamlines the program by discontinuing Track 1, a one-sided risk model,…
Many payers, most notably the Centers for Medicare and Medicaid Services (CMS), have developed new payment models that base reimbursement on a broader bundle of services than traditional fee-for-service payment. The accountable care organization (ACO) program exemplifies the broadest of these new payment models. One of the crucial ACO design features is the extent to…
Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound, provider-accepted and operational Alternative Payment Models (APMs), and attribution is the most critical component of value-based contract design,” the Society of Actuaries recently wrote in…
CMS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven things to know about the proposed rule: 1. The redesigned program — which CMS has dubbed “Pathways to Success” — would expand ACO participation…
