- 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 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.