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.

CMS Announces OCM Participants: Three Notable Facts
July 8, 2016

On June 29, HHS announced its selection of oncology physician group practices and health insurance companies to participate in the Oncology Care model (OCM), a five-year bundled payment initiative that starts July 1 and will cover more than 3,200 oncologists and 155,000 Medicare beneficiaries. The program provides a $160 care management payment per beneficiary per […]

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Bundled Payments Gaining Adoption; Provider Participants Seeking Care Redesign
June 28, 2016

With CJR beginning last April and BPCI being extended for two more years until 2018, bundled payments have established themselves as CMS options for value-based care programs. Adoption looks to continue upward for future years, though, a potential mass adoption could take place if a favorable, future MACRA decision determines that bundled payments qualify for […]

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Oncology Care Model (OCM) Bundle: 8 Summary Thoughts
June 24, 2016

Recently I had the opportunity to research CMS’ Oncology Care Model (OCM) bundle and to interview a number of c-suite individuals across oncology hospitals and clinics. Below please find eight summary thoughts. Difficulty of bundling oncology. Joint replacements (the focus of CMS’ new mandatory bundled payment program) have a clear beginning and end for the episode […]

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LP Data Insight: Medicare Spend by Service Type and Beneficiary Age
June 14, 2016

Using CMS Limited Data Set (LDS) 2013 claims data, I examined the distribution of all Medicare fee-for-service (FFS) costs. The LDS claims file consist of 100% of all FFS claims for inpatient, outpatient, home health, skilled nursing facilities (SNF), and hospice. However, they include only a 5% sample for claims related to durable medical equipment […]

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Comprehensive Primary Care Plus (CPC+): 4 Positive Implications & 2 Practice Strategies
June 9, 2016

As a former primary care clinic manager and COO of a medical group engaged in value-based contracts, I was excited to see CMS’ announcement on Comprehensive Primary Care Plus (CPC+). I welcome this shift in Medicare primary care payments away from the quagmire of Fee-For Service (FFS) and into the higher ground of partial capitation, […]

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Comprehensive Primary Care Plus (CPC+): Transformational Physician Managed Care
June 6, 2016

While primary care is the foundation for effective population health management, traditional reimbursement structures under fee-for-service (FFS) do not facilitate the delivery of high-quality primary care.

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Defining High-Value Behavioral Health Providers for ACO Partnerships
May 16, 2016

This brief offers recommendations for evaluating behavioral health providers. ACOs assessing these providers should be less selective.

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Defining High-Value Post-Acute Care Providers for ACO Partnerships
May 16, 2016

This brief describes the characteristics of high-value post-acute care providers, an industry segment that is becoming increasingly important to ACOs.

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