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.

Centers for Medicare and Medicaid Services (CMS)

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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CMS Announces OCM Participants: Three Notable Facts

July 8th, 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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Oncology Care Model (OCM) Bundle: 8 Summary Thoughts

June 24th, 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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Comprehensive Primary Care Plus (CPC+): 4 Positive Implications & 2 Practice Strategies

June 9th, 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 6th, 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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MSSP ACOs: Financial Savings and the Appetite for More

March 2nd, 2016

CMS’ January 11 announcement of the new and renewing Medicare ACO participants indicated both an increase in the number of ACOs and ACO covered lives.

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The Coming of Mandatory Bundled Care: The Comprehensive Care for Joint Replacement Program (CJR)

January 29th, 2016

On November 16, 2015, the Centers for Medicare and Medicaid Services (CMS) finalized the Comprehensive Care for Joint Replacement (CJR) model, its first mandatory bundled payment initiative.

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