Medicare ACOs and Alternative Payment Models

• The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences

  By Tia Goss Sawhney, Kathryn V. Fitch, Cory Gusland | 16 April 2018

  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.

• An Overview of the Bundled Payments for Care Improvement Advanced Model

  By Samuel Bennett, Pamela M. Pelizzari | 13 March 2018

  This paper outlines the major provisions of the newly announced Bundled Payments for Care Improvement Advanced model.

• Medicare Part D DIR: Direct and indirect remuneration explained

  By Deana Bell, Tracy A. Margiott | 29 January 2018

  As direct and indirect remuneration continues to increase, it is important for Medicare Part D sponsors to consider the effect of potential regulatory changes on plans’ bottom lines and operations.

• Risk adjustment in CMS episode-based payment models: A resource guide

  By Samuel Bennett, Thomas D. Snook | 20 December 2017

  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.

• Addressing challenges in the transition to value-based care and alternative payment models: A case study in the Oncology Care Model

  By Maggie Alston, Christine Ferro, L. Daniel Muldoon, Pamela M. Pelizzari | 11 December 2017

  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.

• Developing alternative payment models under MACRA

  By L. Daniel Muldoon, Pamela M. Pelizzari | 01 December 2017

  This paper explores key clinical and financial considerations that need to be addressed in a robust alternative payment model proposal.

• The future of Medicare's episode-based payments

  By L. Daniel Muldoon, Pamela M. Pelizzari | 21 November 2017

  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.

• Telehealth under alternative payment models

  By Susan Philip | 13 September 2017

  Telehealth has the potential to boost the impact of population health management initiatives while improving access and convenience of healthcare delivery.

• Building a successful value-based payer contracting strategy

  By David V. Williams, David M. Liner, Colleen Norris | 21 February 2017

  This paper introduces three pillars to optimize a provider’s performance with value-based contracts: transparency, stability, and control.

• Medicare Advantage opportunities in innovation

  By Courtney R. White | 22 September 2016

  The Centers for Medicare and Medicaid Services is the latest payer to investigate value-based insurance design by offering an option through the Medicare Advantage program.

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