Value-Based Care

A one-minute look at managed care news during the week of March 9, 2015, including a new ACO model from CMS and the increase in drug spending driven largely by hepatitis C and compounded medications.

CMS announced the Next Generation Accountable Care Organization Model, which takes on greater performance risk but could potentially reap greater rewards.

A group of 700 independent Portland doctors, both primary care and specialty, have come together to for a new accountable care organization.

CMS has proposed several possible changes to the Medicare Shared Savings Program in an effort to attract new participants and to encourage current participants to continue with the program beyond their initial 3-year commitment.

Suzanne F. Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, will be the keynote speaker at the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held April 30 and May 1, 2015, in San Diego, California. The ACO Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across the healthcare spectrum interested in sharing best practices relative to the changing delivery and payment models.

A one-minute look at managed care news during the week of February 23, 2015, including another step by CMS toward a quality-based payment system and more predictions on the outcomes of King v. Burwell.

UnitedHealthcare announced that it will nearly double the amount of accountable care organizations it is contracted with in 2015 as it expects to add another 250 ACOs.

In a study of 10 large health systems, Dartmouth investigators found that implementation of pilot accountable care organizations did not limit spending on discretionary or non-discretionary cardiovascular treatment for patients.

OIG recommends training for inspectors and amending contracts with stand-alone pharmacies to ensure improved quality and safety.

Catalyst Health Network and UnitedHealthcare have launched an accountable care organization to improve care coordination, enhance health services, and reduce the cost of healthcare.

CMS' Sean Cavanaugh announces in a blog post that 89 newcomers will participate in 2015. But ACOs remain a work in progress, with rule changes on the way and some discussion about whether these entities are assuming enough risk or dampening competition in certain markets.

Accountable care organizations (ACOs) are still a new creature in the world of managed care, and not all are alike. As the authors of a new comparative analysis in The American Journal of Managed Care outline, Medicare contracts dominate the ACO landscape, with only half of these entities having a contract with a private payer.

How do ACOs reach the point of delivering both savings and better care? The recent online session of the ACO and Emerging Healthcare Delivery Coalition, sponsored by The American Journal of Managed Care, covered how ACOs evolve, how that process applies to oncology care, and how managed care can benefit from a better model for mental health delivery.

As the ACO and Emerging Healthcare Delivery Coalition gather in Miami, results are coming in, and it's time to figure out just what to measure.

Lifting section 1834(m) restrictions on telehealth services would help ACOs to utilize this beneficial tool to achieve their cost, quality, access, and patient engagement goals.

Optimal use of pharmaceuticals is often overlooked for accountable care organizations (ACOs), but ensuring proper medication use, efficacy, and safety is critical to an ACO's success.

Efforts to improve patient safety in hospitals are paying off: there were 1.3 million fewer adverse events harming patients in 2011, 2012, and 2013, according to a new report from HHS.

Among the dozen revisions to the Medicare Shared Savings Program being considered includes one that could bring some relief to accountable care organizations facing penalties for poor performance.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, held its most recent WebEx session this week. Participants discussed new strategies and technologies that both employers and healthcare organizations can use to get patients to take ownership over their own care.

From Medicaid providers that are regulated as insurers alongside managed care organizations, as happens in Mississippi, to "enhanced medical homes," which are found in Colorado, the variety that exists in healthcare delivery across the states has adapted to reflect the shift to accountable care, according to an author writing for the American Journal of Public Health.

US Health and Human Services Secretary Sylvia M. Burwell announces new progams and financial incentives to help accountable care organizations (ACOs) and professional medical associations make the transition from fee-for-service to value-based healthcare delivery.

An article in the Journal of the American Medical Association outlines what both CMS and the Pioneer ACOs have learned in the early years of the program, such as the importance of engaging primary care physicians, not growing too quickly, and the need to find better ways to count which patients are in the ACO.