Two influential advisory groups sent recommendations to Congress calling for a revamp of how health plans are paid in the lucrative Medicare Advantage program, culling how many models CMS tests and curbing high-cost drug approvals. By many measures, the MA program has been thriving. Enrollment and participation has continued to grow, and in 2021, MA…
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…
Population health and fee-for-service are not a rigid dichotomy. Treating them as such misses a major opportunity for healthcare executives looking to advance strategies to protect fee-for-service payments and volumes from eroding while preparing for the eventuality of a greater share of revenue coming from risk. I should know. At my organization, I am the…
Year after year, surveys show the same thing: Healthcare providers’ evolution toward accepting risk to keep patients healthy—widely viewed as the holy grail of lowering healthcare costs—has been painfully slow. So long as that’s the case, experts say the financial returns providers can expect to draw from population health management, where they gather patient data…
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…
Accountable care organizations (ACOs) taking on the greatest financial risk in Medicare through the Next Generation ACO Model saved the public payer over $558 million in 2019, according to partial data from CMS. CMS released the data yesterday on 37 of the 41 Next Generation ACOs participating in 2019. The data excluded savings and quality data from…
Value-based providers, like accountable care organizations (ACOs), may be at a disadvantage under new direct contracting options in Medicare that allow for a broad range of healthcare organizations to participate, according to the National Association of ACOs (NAACOS). In a letter to CMS Innovation Center Director Brad Smith, the industry group called for changes to both the…
CMS is proposing to change quality reporting standards in the Medicare Shared Savings Program and accountable care organizations are pushing back. In the 2021 proposed physician fee schedule rule released Aug. 3, CMS proposed three main changes related to quality: a new mechanism for ACOs to report quality measures, a reduction in the Medicare Shared Savings Program’s…
A national primary-care physician association and an employer group have teamed up to develop a care model that aims to shift away from fee-for-service reimbursement. The American Academy of Family Physicians and National Alliance of Healthcare Purchaser Coalitions plan to leverage regional employer coalitions and physician networks to form a national primary-care model based on…
Primary care practices need new ways of being paid if they are going to survive and thrive in the wake of the COVID-19 pandemic, several speakers said Wednesday during a webinar hosted by the Alliance for Health Policy. “Fee-for-service is simply not a system this is conducive or amendable to primary care being able to thrive…
