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Aug 25, 2017 10:00:00 AM

Why Your Hospital or Physician Practice Must Embrace Risk

Risk tolerance is an interesting thing. Those who make the biggest bets often are actually control freaks—maybe because they know that, by having a strong grasp on the factors that influence the deal, they greatly increase the likelihood that they will come out ahead.

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Topics: ACO, MACRA, Cost Accounting, Value-Based Pay, Risk Management

Jul 13, 2017 11:00:00 AM

What’s the Value of Innovation? (Part 2)

The previous installment of this blog series described the CMS Innovation Center and its mission to test innovative payment and delivery models and to implement the MACRA Quality Payment Program (QPP).

The QPP is designed to help achieve HHS’ goal of tying half of Medicare fee-for-service payments to quality or value through Advanced Payment Models (APMs) by 2018. Advanced APMs, one of the two tracks of MACRA, allows physician practices to earn more by assuming some financial risk related to patients’ outcomes. Certain Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), including the new MSSP Track 1+ ACO, qualify as Advanced APMs.

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Topics: ACO, Value-Based Care, MACRA, Valuation, APMs, QPP

Jun 22, 2017 4:00:00 PM

What’s the Value of Innovation? (Part 1 in a 2-part series)

The Affordable Care Act created the CMS Innovation Center to allow Medicare and Medicaid programs to test innovative payment and delivery models that improve patient care and lower healthcare costs.

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Topics: Affordable Care Act, ACO, ACA, APMs

Jan 5, 2017 10:30:00 AM

Medicare-Medicaid ACO Model: Urge Your State to Apply by Jan. 20

January 20 is a significant date for healthcare providers—but not necessarily for the reason you think.

Yes, there is the inauguration of the 45th President of the United States, who has vowed to “repeal and replace” the most significant healthcare legislation in recent history.

But that date has even greater significance for the many providers across the country who are struggling to cover the cost of care of an increasingly high-risk, low-income population.

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Topics: Medicare, ACO, Medicaid

Oct 11, 2016 11:00:00 AM

Preparing for Payment Reform: Shared Savings Arrangements

Shared savings arrangements began as a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act, the intent being threefold: to generate better care for individuals, to generate better health for the population, and to lower growth expenditures. To participate in a Medicare shared savings arrangement, eligible providers and suppliers are required to form an accountable care organization (ACO).

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Topics: ACO, MACRA, Payment Models

Jul 17, 2015 2:00:00 PM

How a Rapidly Changing Market is Affecting the Value of ASCs

The ambulatory surgery center (ASC) market has seen a lot of growth and success since first arriving on the scene over 40 years ago. While the ASC market has grown significantly over this time, that growth has slowed in the last 10 years and ASCs now appear to be operating in a “maturing” market. At the same time we are seeing rapid change in the market where ASCs operate and many of these changes may have a significant impact on the value of ASCs. Below are some of those areas that could have tremendous impact on ASC values.

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Topics: Healthcare Facilities, ACO

Jun 11, 2015 10:24:00 AM

Can ACO’s Live Up to Expectations?

I was fortunate to have been invited to co-author a chapter on merit-based savings distribution models in The ACO Handbook: A Guide to Accountable Care Organizations, Second Edition with Bo Bobbitt.  Bo is a seasoned health care attorney who works with many ACOs and clinically integrated networks. He is with the Smith Anderson law firm in Raleigh, North Carolina, and speaks and writes on this subject extensively.

Breaking down the siloes that exist in our fragmented healthcare system requires the collaborative commitment of clinicians and facilities, and true clinical integration fosters (and, in turn, is promoted by) teamwork, transitional care, reduction in clinical variation, and information-sharing. For the ACO model to be successful, a correlation must exist between financial incentives and the common goals of improving experience of care for patients, improving the health of populations, and reducing the per capita cost of healthcare. 

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Topics: ACO, Triple Aim

Mar 12, 2015 9:23:20 AM

3 Strategies to Become an ACO

The early experience with ACOs has not been very good. The cost of implementation has been higher than expected, and population health management has been difficult to achieve. Data released last October showed that out of 220 CMS ACOs, only 52 were able to share savings, and 115 ACOs had no cost savings. The CMS ACO spend was reduced by a paltry 1%.

So why were the results so underwhelming? It was harder to reduce costs than expected. Low hanging fruit did not exist. The outcomes could have been better if they had deployed these three important strategies.

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Topics: ACO, Population Health

Dec 11, 2014 8:54:00 AM

Challenges of Accountable Care Organizations

As health care evolves from fee-for-service to shared-savings model, accountable care organizations are a key component in driving this evolution. ACOs can be broadly defined as: "a group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients." This concept places the financial risk of each patient's care on the group of providers.

There have been many obstacles blocking the success of implementing the ACO model nationwide. At a recent summit, I attended a session about why ACOs have not been successful, and many challenges were discussed, such as:

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Topics: ACO