Our Latest Thinking

We are constantly scanning the health care market for new and interesting developments; then we write about them here. Check out our latest thinking.

Medicare

CJR: Playing the Waiting Game

June 6th, 2017

On April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) model program took effect, affecting roughly 800 hospitals across 67 markets.  Prior to the program becoming active, Leavitt Partners published a blog post stating, “Time will tell whether hospitals and providers will succeed with quality improvements and savings generation under this new program.” One […]

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Maryland and Vermont: Lessons in Health Care Reform

June 5th, 2017

Introduction During the 1970s, in an effort to limit rising health care expenditures, several states adopted various forms of all-payer rate-setting models, where all payers pay the same price for services at a given facility. Over time, most state models failed and only Maryland’s all-payer hospital rate-setting system remains. Recently, there is renewed interest in […]

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The MACRA All-Payer Advanced APM Pathway: System-Wide Implications

May 3rd, 2017

Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, […]

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Six Characteristics of Successful Post-Acute Care (PAC) Value Networks

April 18th, 2017

Between 2001 and 2015 Medicare payments to post-acute care (PAC) providers more than doubled.[1] As such, PAC represents a growing opportunity for value-based entities such as accountable care organizations (ACOs), bundled-payment model participants, and medical groups to create savings in overall spend. Consider that five percent of Medicare beneficiaries account for almost 50 percent of […]

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Overview, Impact & Strategic Considerations of the Quality Payment Program

March 31st, 2017

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.

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Analysis of 52 PAC Trends

November 28th, 2016

PAC represents the next frontier of opportunity for the success of ACOs, BPCI Model 2 participants, and CJR hospitals. In fact, of the ACOs which achieved shared savings, most attribute their success to closer PAC care coordination. Hospitals are narrowing networks, wanting to find the best PAC partners possible, and stronger care pathways and coordination are taking place at unprecedented levels.

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The Cost of Quality: How Star Ratings Can Influence Monthly Premiums in Medicare Advantage Plans

November 14th, 2016

The Centers for Medicare and Medicaid Services assigns a star rating to Medicare Advantage plans to help beneficiaries better understand and select their insurance plan.

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Medicare Advantage: CMS’ First Step into Value Based Care is Now Coming Full Circle

September 1st, 2016

Medicare Advantage (MA) offers Medicare benefits through private health plans, providing an alternative to the traditional, federally-administered program. Also known as Medicare Part C, this private option traces its roots to the 1970s and received its current name and form in the Medicare Modernization Act of 2003. Since then, the number of enrollees has grown […]

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