Value-Based Care

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

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.

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.

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.

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.

Physician practices intending to join Medicare accountable care organizations (ACOs) in 2012 had greater capabilities in health information technology, care management processes, and quality improvement methods than those not intending to join, but they still were far from using all recommended behaviors to manage risk.

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.

Accountable care organizations (ACOs) often care for patients with complex, chronic conditions that can lead to high expenditures and utilization of care. During a session at the National Association of ACOs Fall 2018 conference, being held October 3-5 in Washington, DC, panelists discussed how ACOs can design and implement strategies that deliver high-quality, low-cost care for these patients.

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.

More frequent electronic health record (EHR) message forwarding in primary care teams is associated with worse outcomes and higher medical costs for patients with diabetes.

At the National Association of ACOs Fall 2018 conference, being held October 3-5 in Washington, DC, panelists shared successful innovative initiatives that have been developed by their accountable care organizations (ACOs). What worked and what did not was the focus of the conversation led by Debbie Welle-Powell, chief population health officer, Essentia Health.

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.

For 2017, New Jersey's largest insurer made particularly good progress in certain diabetes measures and in cancer screenings.

Optimal end-stage renal disease (ESRD) starts were associated with lower 12-month morbidity, mortality, and inpatient and outpatient utilization in an integrated healthcare delivery system.

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.

CMS implemented the Categorical Adjustment Index as part of the Medicare Advantage and Part D Star Rating Program in 2017. These analyses informed its development. Check out our website’s new table/figure pop-up feature! Click on the name of a table or figure in the text to see it in your browser.

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.

This week, the top managed care stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms the value of daily aspirin for patients with diabetes.

Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, explains how her organization is helping employers better understand accountable care organizations (ACOs) and judge how the ACO model might work with their population.

In 2016, the Next Generation Accountable Care Organization (ACO) model generated a net savings of $62 million to Medicare, representing a 1.1% net reduction in Medicare spending. In a webcast with the Accountable Care Learning Collaborative, CMS Administrator Seema Verma called the results a strong start and offered a look at what's in the future for the model.

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.

This week, the top managed care news included a panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work.

Physician- and nursing staff–reported team functioning was associated with patient satisfaction but not with clinical quality or patient portal implementation.

Providing patient-centered comprehensive care to long-term cancer survivors may lead to reduced total healthcare expenditures. Check out our website’s new table/figure pop-up feature! Click on the name of a table or figure in the text to see it in your browser.

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.

Robert A. Gabbay, MD, PhD, FACP, chief medical officer and senior vice president at Joslin Diabetes Center, said health systems need people with the skill sets that diabetes educators possess to make the transition to a reimbursement system based on quality, prevention, and eliminating costs.

Accountable care organizations (ACOs), either directly or indirectly, are affecting physician employment patterns in regions where they have high penetration.

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

This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.