Medicare ACOs and Alternative Payment Models

Pathways to Success: MSSP proposed rule: Integrity
By Jason Karcher, Brian A. Sweatman | 01 November 2018

This paper discusses ways in which accountable care organizations have been identified by the Centers for Medicare and Medicaid Services (CMS) as weakening integrity and how CMS is proposing to address concerns.
Pathways to Success: MSSP proposed rule: Assignment changes to identification of E&M Services in skilled nursing facilities
By Anders Larson, Jill S. Herbold | 19 October 2018

This paper discusses the current and proposed rules related to evaluation and management services in the Medicare Shared Savings Program.
Population-based payments (PBPs) open door for ACOs to more effectively manage care
By Noah Champagne, Jason McEwen | 16 October 2018

The Next Generation accountable care organization (ACO) model introduced a provider payment mechanism called population-based payments that allow ACOs to negotiate provider payment rates and may allow more effective management of resource use.
Impact of Next Generation ACO Model on Medicare spending in 2016
By Hugh Larson, Annie Man, Timothy J. Wilder, Coleen Young | 15 October 2018

This paper combines the aggregate gross impact of each of the Next Generation Accountable Care Organizations (NGACOs) shown in the NORC report with the shared savings/(loss) results of each NGACO to calculate the net impact of each individual NGACO.
Pathways to Success: MSSP proposed rule: Winners and losers
By Anders Larson, Cory Gusland | 03 October 2018

All accountable care organizations (ACOs) will be affected by the Medicare Shared Savings Program if enacted, and the impact of the rule change will vary by ACO depending on its current situation and unique characteristics.
Pharma APMs: A learning curve awaits you, pharma
By Maggie Alston, Bruce S. Pyenson | 02 October 2018

There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistical challenges—some of which are unique to the pharmaceutical industry.
Opportunities for care coordination through innovative technologies
By Susan Philip, Carol Bazell, Laurie Lingefelt | 24 September 2018

This paper discusses how accountable care organizations (ACOs) can increase their use of telehealth and other innovative non-face-to-face services in response to opportunities arising from new CMS policies and/or environmental changes.
Alternative payment model financial settlements: Preparing for and learning from the process
By Christine Ferro, Maggie Alston, L. Daniel Muldoon, Pamela M. Pelizzari | 17 September 2018

This paper focuses on alternative payment model reimbursement methodologies through the lens of the Centers for Medicare and Medicaid Services Oncology Care Model as an illustrative case study.
Pathways to Success MSSP proposed rule: Beneficiary assignment
By Colleen Norris, Jason McEwen, Jonah Broulette | 07 September 2018

This paper describes how the impact of the rule change will vary by ACO depending on its current situation and unique characteristics and examines the rule from the perspective of different ACO situations.
Pathways to Success: MSSP proposed rule: Financial benchmark
By Jill S. Herbold, Cory Gusland, Charlie Mills | 28 August 2018

This paper discusses “Pathways to Success” and the important implications in store for Medicare accountable care organizations.

See More Articles

20 August 2018
Pathways to Success: MSSP proposed regulation: Summary white paper
This paper provides a summary of the Centers for Medicare and Medicaid Services’ sweeping proposed regulations that will significantly change the Medicare Shared Savings Program.
16 April 2018
The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences
This article describes the changes in the historical benchmarks and performance expenditures for a number of Medicare Shared Savings Program accountable care organizations and also explains the possible impact of these changes.
13 March 2018
An Overview of the Bundled Payments for Care Improvement Advanced Model
This paper outlines the major provisions of the newly announced Bundled Payments for Care Improvement Advanced model.
06 March 2018
Is your provider organization maximizing its performance in value-based care programs?
As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.
20 December 2017
Risk adjustment in CMS episode-based payment models: A resource guide
This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.
11 December 2017
Addressing challenges in the transition to value-based care and alternative payment models: A case study in the Oncology Care Model
This paper highlights the key aspects of alternative payment model payment methodologies and uses the Centers for Medicare and Medicaid Services Oncology Care Model as a case study to illustrate these concepts.
01 December 2017
Developing alternative payment models under MACRA
This paper explores key clinical and financial considerations that need to be addressed in a robust alternative payment model proposal.
21 November 2017
The future of Medicare's episode-based payments
Given the many drivers of change in payment and service delivery reform recently, providers that have been working to redesign their care delivery to align with the value-based payment goals of Medicare are asking themselves if value-based payment is here to stay and whether it is worth the continued investment.