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.

Alternative Payment Models

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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So You’re Thinking about Bundling: Where to Start & With Whom

May 15th, 2017

Bundled payments are a great option for organizations that are interested in taking on risk, but don’t have the appetite to form an ACO. Bundle payments group costs associated with a particular treatment or episode of care, offering health systems a longitudinal look at the care cycle that can help them efficiently allocate resources. The CMS Bundled […]

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The “Exit Polls”: Initial Thoughts on PTAC’s First Meeting

May 11th, 2017

Background The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further […]

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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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Accountable Care Organizations and Risk-based Payment Arrangements: Strong Preference for Upside-Only Contracts

November 30th, 2016

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).

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Improving Health Outcomes Through Prevention

October 27th, 2016

To succeed, value-based models need to broaden their focus to include identifying the rising-risk population and proactively incorporating interventions to prevent exacerbations of unmanaged chronic conditions.

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CMS Proposes New Mandatory Bundled Payment Models: 4 Observations

July 29th, 2016

On July 25, 2016, CMS announced a proposed rule to provide additional incentives for hospitals to provide higher quality care at a lower cost. The proposed rule seeks to increase coordination of care and decrease costs for heart attack and bypass surgery patients, creates a new Surgical Hip/Femur Fracture Treatment model (SHFFT), and outlines a […]

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Bundled Payments Gaining Adoption; Provider Participants Seeking Care Redesign

June 28th, 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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