Insurance

This week, the top managed care news included the Trump administration unveiling plans to include drug prices in television ads; CMS touted Medicare Advantage at the beginning of open enrollment for Medicare; research found Medicare beneficiaries who live in housing with support services stay out of the hospital.

CMS Administrator Seema Verma touted the growth in enrollment in Medicare Advantage programs during an appearance at a conference run by America’s Health Insurance Plans on Tuesday.

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.

Private payers are getting more engaged in accountable care organizations (ACOs), said Clif Gaus, ScD, president and CEO of the National Association of ACOs.

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.

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.

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.

Under the current administration, CMS has made several good-faith attempts to revitalize the current healthcare system. These efforts demonstrate CMS’ commitment to move our industry closer to value-based payment and consumer-centered delivery models. However, each of these reforms exhibits concerning characteristics.

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.

CMS’ accountable care organization program, the Medicare Shared Savings Program (MSSP), could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs (NAACOS), the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment.

The actual costs of implementing the evidence-based Diabetes Prevention Program (DPP) were compared with the latest reimbursement rates provided by CMS.

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.

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.

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).

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

This week, the top managed care news included the Nobel Prize in Medicine was awarded to 2 people for research into immunotherapy; physician-run accountable care organizations bring savings for Medicare; research highlights the health impacts of sexual harassment and assault.

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.

The outpatient community oncology setting is consistently less costly for cancer treatment as opposed to the outpatient hospital setting.

Our study provides the first evidence on site-specific Medicare spending on chemotherapy adjusting for patient comorbid illnesses, cancer type, and other cancer-related risks.

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.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

A profile of a program that calls for residents in a rural area to become full partners in managing their type 2 diabetes, and in the process bring changes to their community.

A former president of the American Association of Diabetes Educators addresses the need to remodel diabetes self-management education and support, to create a reimbursement system that better meets the needs of today's providers and patients.