- Pathways to Success MSSP final rule: Financial benchmark
By Jill S. Herbold, Cory Gusland, Charlie Mills, Matthew J. Kramer | 22 February 2019
This paper discusses the changes to the financial benchmark methodology that measures the gross savings or losses of an accountable care organization under the Medicare Shared Savings Program.
- Pathways to Success MSSP final rule: Winners and losers
By Anders Larson, Cory Gusland | 14 February 2019
This paper examines the Medicare Shared Savings Program’s (MSSP) final rule from the perspective of different accountable care organization (ACO) situations to help readers understand how the MSSP rule might affect different ACOs.
- Seven key challenges for Medicaid states considering alternative payment models
By Anders Larson, Rebecca L. Johnson, Zach Hunt | 29 January 2019
This article focuses on some of the challenges that Medicaid payers (including states and managed care organizations) face when trying to establish alternative payment models with providers.
- Pathways to Success MSSP final rule: Key revisions to the proposed rule
By Noah Champagne, Charlie Mills, Jason Karcher | 07 January 2019
This paper summarizes the key provisions of the final rule for the 2019 Medicare Shared Savings Program and highlights differences from the Centers for Medicare and Medicaid Services’s August proposal.
- 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 Eamp;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.