Alternative Payment Models

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Value-Based Care Veterans, Surprised by EOM Results, Ponder Next Move
Value-Based Care Veterans, Surprised by EOM Results, Ponder Next Move

September 11th 2025

Community oncology leaders navigate challenges in value-based care under the Enhancing Oncology Model, facing performance payment uncertainties and evolving drug markets.

Daniel C. Kendzierski, PharmD, BCOP | Image: LinkedIn
Remote Clinical Pharmacists Saved Nearly $9M, Helped Practices Meet EOM Targets

August 21st 2025

AJMC
Utilization and Costs Among Oncologists Participating in a Private Insurance Shared Savings Model

June 11th 2025

McKesson logo | Image credit: McKesson
Once Again, CMS Selects McKesson’s Practice Insights as a Qualified Clinical Data Registry

January 28th 2025

Doing Things Differently: Wilfong Moves to Thyme Care
Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

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Stephen Nuckolls Outlines His Greatest Challenges and Opportunities of the Proposed MSSP Changes
October 23rd 2018

Stephen Nuckolls Outlines His Greatest Challenges and Opportunities of the Proposed MSSP Changes

The proposed risk adjustment changes to the Medicare Shared Savings Program (MSSP) are welcome but moving accountable care organizations (ACOs) to risk too soon could harm the program, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
Payments Are Increasingly Tied to Value, but More Risk-Based Models Needed
October 23rd 2018

Payments Are Increasingly Tied to Value, but More Risk-Based Models Needed

Laura Joszt, MA
Approximately one-third of all US healthcare payments in 2017 were tied to alternative payment models, with the remaining still tied to fee for service. The findings of the Health Care Payment Learning and Action Network report highlighted that even as payments move to value-based models, more spending in models with risk is needed.
ACO Engagement With Urologists Can Reduce Overtreatment of Prostate Cancer
October 21st 2018

ACO Engagement With Urologists Can Reduce Overtreatment of Prostate Cancer

Laura Joszt, MA
Accountable care organizations (ACOs) in the Medicare Shared Savings Program vary considerably in how they treat men with newly diagnosed prostate cancer, according to a study that assessed whether the level of engagement in ACOs by urologists could affect rates of treatment, overtreatment, and spending in prostate cancer care.
Dr Rob Fields Discusses Why More ACOs Might Turn to Medicare Advantage
October 21st 2018

Dr Rob Fields Discusses Why More ACOs Might Turn to Medicare Advantage

The push to get accountable care organizations to take on risk faster could lead to more participation in Medicare Advantage, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.
Dr Joe Antos: Proposed MSSP Changes Not a Major Shift in Policy for ACOs
October 18th 2018

Dr Joe Antos: Proposed MSSP Changes Not a Major Shift in Policy for ACOs

CMS’ proposed changes to the Medicare Shared Savings Program (MSSP) doesn’t represent a major shift in policy stance toward accountable care organizations (ACOs), said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.
Value-Based Payment Success Hinges on a Holistic Strategy for Changes
October 17th 2018

Value-Based Payment Success Hinges on a Holistic Strategy for Changes

Laura Joszt, MA
Piecemeal solutions to implement value-based payment arrangements will not be able to effectively enact change. Authors in The New England Journal of Medicine argue that a range of complementary solutions need to be pursued simultaneously based on previously successful tactics on a smaller scale.
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October 16th 2018

Squaring Value-Based Payment With Innovation in Oncology

Mary Caffrey
Finding a place for value-based payment with the fast paced innovation in oncology.
Allison Brennan: Trump's Administration Is Encouraging Risk, but Possibly Too Quickly
October 16th 2018

Allison Brennan: Trump's Administration Is Encouraging Risk, but Possibly Too Quickly

By encouraging more providers to take on risk faster, the current administration may actually be disincentivizing providers from participating at all, which would reduce the number of accountable care organizations (ACOs), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.
Dr Clif Gaus: Private Payer Engagement in ACOs Is Up
October 15th 2018

Dr Clif Gaus: Private Payer Engagement in ACOs Is Up

Private payers are getting more engaged in accountable care organizations (ACOs), said Clif Gaus, ScD, president and CEO of the National Association of ACOs.
ACOs Had No Significant Impact on Spending for Patients With Cancer
October 14th 2018

ACOs Had No Significant Impact on Spending for Patients With Cancer

Laura Joszt, MA
Accountable care organizations (ACOs) have not had a significant impact on cancer care costs and utilization. While cancer care costs did decline from before the introduction of ACOs to after, there was no significant difference in spending decreases between ACO practices and non-ACO practices caring for patients with cancer.
Stephen Nuckolls: 2 Years Isn't Enough Time for an ACO to Take on Risk
October 14th 2018

Stephen Nuckolls: 2 Years Isn't Enough Time for an ACO to Take on Risk

The proposed changes to the Medicare Shared Savings Program that move accountable care organizations (ACOs) to take on risk in just 2 years is not going to be enough time for most ACOs, although some may be ready in that time, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
The US Oncology Network Announces Highly Positive MIPS Results for 2017
October 12th 2018

The US Oncology Network Announces Highly Positive MIPS Results for 2017

Laura Joszt, MA
Practices in the US Oncology Network received an average positive payment adjustment under the Merit-based Incentive Payment System (MIPS) of 1.90% for performance in 2017, and 99% of the Network’s physicians were in the top tier of performers. The maximum allowable adjustment is 2.02%. The adjustment based on a clinician’s performance in 2017 impacts the clinician's Medicare reimbursement for 2019.
Dr Katherine Schneider on Handling Variability in ACO Contracts
October 10th 2018

Dr Katherine Schneider on Handling Variability in ACO Contracts

Contracts for accountable care organizations (ACOs) can be very different depending on who the payer is, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
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October 9th 2018

Are Commercial Payers Experiencing Success With ACO Partnerships?

Surabhi Dangi-Garimella, PhD
At the National Association of ACOs Fall 2018 conference, private payers discussed how they are working with accountable care organizations (ACOs) to create new opportunities in the commercial market.
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October 8th 2018

Predictability and Simplicity Needed to Help ACOs Take on Risk, Panelists Say at NAACOS

Laura Joszt, MA
During the opening plenary and panel at the fall 2018 meeting of the National Association of ACOs (NAACOS), Adam Boehler, of the Center for Medicare and Medicaid Innovation, highlighted the fact that CMS has to provide predictability and simplicity to get more accountable care organizations to take on risk and succeed, but that those who are not "cutting it" should "get out of the way" for others.
Dr Rob Fields Discusses How the Proposed MSSP Changes Impact Decisions Around ACOs
October 8th 2018

Dr Rob Fields Discusses How the Proposed MSSP Changes Impact Decisions Around ACOs

Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System, discusses how Mount Sinai’s accountable care organizations (ACOs) will have to adjust to the proposed CMS Medicare Shared Savings Program (MSSP) changes.
Dr Clif Gaus Highlights Excitement and Anxiety at NAACOS Fall 2018 Meeting
October 6th 2018

Dr Clif Gaus Highlights Excitement and Anxiety at NAACOS Fall 2018 Meeting

Accountable care organizations (ACOs) are of 2 minds right now. On the one hand, there is a lot of excitement for the future of ACOs, but there is also great anxiety around the changes that CMS proposed for the Medicare Shared Savings Program (MSSP), said Clif Gaus, ScD, president and CEO of the National Association of ACOs (NAACOS).
Cancer Types Can Impact How Well Providers May Perform Under OCM
October 5th 2018

Cancer Types Can Impact How Well Providers May Perform Under OCM

Laura Joszt, MA
The type of cancer a provider treats can determine how well he or she performs under the Oncology Care Model (OCM), according to research from Avalere Health that was presented at the American Society of Clinical Oncology Quality Care Symposium.
Dr Joe Antos: CMS' Proposed MSSP Changes Don't Account for Variability in Healthcare
October 5th 2018

Dr Joe Antos: CMS' Proposed MSSP Changes Don't Account for Variability in Healthcare

The proposed CMS regulation to change the Medicare Shared Savings Program (MSSP) so that accountable care organizations (ACOs) take on risk faster creates a one-size-fits-all model that doesn’t allow for variability, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.
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October 4th 2018

Making the Leap to Prospective Risk in Value-Based Oncology Care

Mary Caffrey
The Institute for Value-Based Medicine travels to New York City to learn how technology and trust are key to making the leap to two-sided risk.
Physician ACOs Associated With Growing MSSP Savings Over 3 Years
September 30th 2018

Physician ACOs Associated With Growing MSSP Savings Over 3 Years

Laura Joszt, MA
Not only do physician-group accountable care organizations (ACOs) save Medicare more money than hospital-integrated ACOs, but the savings of physician ACOs grew substantially over 3 years.
Dr Suzanne Delbanco: Employers Have a History of Pushing for Healthcare Transformation
September 26th 2018

Dr Suzanne Delbanco: Employers Have a History of Pushing for Healthcare Transformation

Since they foot the bill for a lot of Americans’ healthcare costs, employers have a lot vested in the health of their populations and have been involved with pushing for healthcare transformation, said Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform.
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September 25th 2018

Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers

Caravan Health
CMS’ proposed rule described strong financial results from low-revenue ACOs, as well as ACOs in risk-bearing tracks, but it mostly ignored the success of small, rural providers in ACOs.
Review Finds Mixed Results for APMs and New Care Delivery Models in Cancer
September 23rd 2018

Review Finds Mixed Results for APMs and New Care Delivery Models in Cancer

Laura Joszt, MA
With cancer costs rising and patients with cancer disproportionately facing financial toxicity, alternative payment and care delivery models are thought to help alleviate some of the cost burden. However, a review finds limited evidence available to evaluate the efficacy of alternative payment and care models in cancer care.
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September 21st 2018

MSSP Proposal Better Measures Risk With Changes to the Benchmark Methodology

Travis Broome, MPH, MBA
CMS' Medicare Shared Savings Program proposal would make substantial changes to the benchmarking methodology for accountable care organizations.
NAACOS-Funded Study: ACOs Saved the Government $541.7M in 2013-2015
September 19th 2018

NAACOS-Funded Study: ACOs Saved the Government $541.7M in 2013-2015

Laura Joszt, MA
A new report contradicts CMS’ claim that the Medicare Shared Savings Program increased Medicare spending by $344 million from 2013 to 2015. The new analysis finds that accountable care organizations (ACOs) actually reduced federal spending by $542 million after accounting for shared savings payments earned.
NCCN Working Group Policy Recommendations Address Changing Paradigms in Cancer Care
September 16th 2018

NCCN Working Group Policy Recommendations Address Changing Paradigms in Cancer Care

Jaime Rosenberg
A National Comprehensive Cancer Network (NCCN) working group dedicated to analyzing current challenges under existing policy and treatment paradigms presented their findings and recommendations at an NCCN Policy Summit in Washington, DC.
Delivering High-Quality Care Under Value-Based Payment Models: Where Are We Now?
September 15th 2018

Delivering High-Quality Care Under Value-Based Payment Models: Where Are We Now?

Jaime Rosenberg
As the term “value” has become a norm in healthcare, specifically in oncology, panelists at a National Comprehensive Cancer Network policy summit offered perspectives on where we are now in delivering high-quality cancer care under value-based payment models.
Cautious Optimism: OCM Participants Seem to Have Improved in Performance Period 2
September 13th 2018

Cautious Optimism: OCM Participants Seem to Have Improved in Performance Period 2

Laura Joszt, MA
An early review of the second performance period of the Oncology Care Model (OCM) seems to show improvements over the first period.
Medical Groups Tell CMS to Stand Down From Linking Reimbursement to Paperwork Burdens
September 11th 2018

Medical Groups Tell CMS to Stand Down From Linking Reimbursement to Paperwork Burdens

Allison Inserro
Over 14,600 comments poured into CMS to meet a deadline to comment about proposed changes to its 2019 physician fee schedule for Medicare, with many physician organizations and individuals asking the agency to halt or slow down its plans to cut physician reimbursement for evaluation and management services. While some groups cheered some of the changes—such as broader coverage for telehealth and other digital monitoring—most expressed many concerns.
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