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The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs). CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality. However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.
The Comprehensive Care for Joint Replacement (CJR) bundled payment model is a Centers for Medicare and Medicaid Services (CMS) initiative that is designed to incent hospitals to reduce the widespread cost variation in hip and knee replacements, and post-operative hospital readmissions throughout the United States. Originally announced in 2015 and revised in 2017, hospitals in
34 markets will be required to participate in the model, including being subject to downside risk, beginning January 1, 2018.
The Affordable Care Act (ACA) established health insurance marketplaces for two purposes: to allow individuals to purchase insurance and gain subsidies for that insurance, and to increase competition and product comparability among insurers. Many Americans are using the federal and state-based exchanges to purchase coverage. In 2017, 12.2 million people selected policies through the marketplaces. With so many Americans buying health care […]
In an effort to increase care coordination and decrease health care costs across the care continuum, many health systems and hospitals are reconfiguring their relationship with post-acute care (PAC) providers. The momentum for change is driven in part from government-initiated efforts that hold hospitals and health systems responsible for the cost and quality of care delivered beyond the four walls of […]
Post-acute care (PAC) covers a range of health care services after hospitalization, including Long-Term Acute-Care (LTAC) hospitals, Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health (HH) agencies. Historically, health systems had little reason to closely integrate with PAC providers or even examine PAC providers on measures of cost and quality, largely because […]
In April 2015, Congress enacted a law that alters the method by which physicians and other health care providers are paid for Medicare Part B services. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the sustainable growth rate formula with physician payments tied to quality. Providers must choose either significant performance-based payments […]
Nearly 1.7 million new cancer diagnoses in the United States are projected for 2017. Controlling the cost of treating cancer is an important consideration for curbing the overall cost of health care. We conducted a systematic review of the literature on the cost of treating cancer in the two most common cancer treatment locations, the […]
The Trump Administration and Republican-controlled Congress appear resolute on repealing major components of the Affordable Care Act (ACA). While a significant amount of uncertainty surrounding the content and timing of a replacement still exists, some Congressional leaders have reached out to states to explore options that would encourage innovative health care solutions at the state level. The new administration has […]
A Leavitt Partners blog entitled “CMS ACOs and the future of the movement,” authored by Tianna Tu in March 2016, was featured in an American Journal of Managed Care article entitled “The Post-Election Future of ACOs.” The article notes that “As of March 2016, The Leavitt Partners’ databases tracked a total of 840 current ACO […]
Providers that are newly pursuing value-based care can determine how to be successful by examining the experiences of current and past accountable care organizations (ACOs). Using the Leavitt Partners ACO taxonomical framework, we examined survey responses from a target population of ACO leaders to identify patterns in risk assumption and an ACO’s organizational, leadership, and […]