On August 9, 2018, CMS issued new proposed regulations for MSSP ACOs that, if finalized, will result in far-reaching changes in the program. The motivation for the proposed changes, which CMS calls “Pathways to Success,” is simple: CMS wants to move ACOs to risk more quickly. The great majority of 2018 participating ACOs are not […]
Performance results were recently released for the 5th year of the Medicare Shared Savings Program (MSSP). These results show that a small but growing proportion of ACOs continue to earn shared savings from Medicare, as shown below. This data comes at a pivotal moment for Accountable Care Organizations (ACOs) as they rush to determine how […]
Veralon’s health system clients have achieved significant savings using Quanto to identify value-based improvement targets and provide the financial management reports to manage to those targets; client savings have varied from over $1 million to $13 million. Quanto was developed by Veralon and by Health Data Innovations, a leader in healthcare data integration. We partnered to make […]
What CMS bundled payment initiative are we on? It can be hard to keep track. First there was the Bundled Payments for Care Improvement (“BPCI”) model, a voluntary bundled payment program beginning in 2013. Then in 2016, CMS introduced the CJR (Comprehensive Joint Replacement) bundled payment model, which was initially mandatory in 67 MSAs […]
Accountable Care Organizations (“ACOs”) receive a substantial portion of their revenue through shared savings programs in which payers pay the ACO a portion of total cost savings generated by member providers through effective care management. The ACOs then distribute part of the shared savings to participating healthcare providers, based on a distribution formula; the remainder […]
Despite many uncertainties, the shift toward value based payment continues. More Medicare Shared Savings Program (MSSP) ACOs have entered risk-based tracks (Tracks 2, 3, and now Track 1+), to take advantage of MACRA’s[1] 5% bonus to physicians in risk-based payment models. The latest numbers about exactly how many have selected risk for next year will […]
Clinically Integrated Networks (CINs) need quality data to understand their patient population and manage provider practice patterns. That makes information technology (“IT”) critical at any stage of CIN development. For CINs with a mix of employed and independent physicians, IT is likely to be a tale of two cities – the employed physicians have solid, […]
CMS wants more physicians to participate in ACOs and other alternative payment models (APMs). It’s best if they are risk-taking ACOs, but any ACO seems to be better than none. At least, that is what the incentives in MACRA seem to indicate. Prior to the passage of MACRA (the Medicare Access and CHIP Reauthorization Act […]
John M. Harris and Craig E. Holm describe howimplementation of MACRA bring significant strategic implications for hospitals and health systems as well and physicians.