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Alternative Payment Models

The move to value-based care has been a long process in the United States, perhaps made even longer by policies that some view as discouraging providers and health systems from participating in alternative payment models and now a pandemic that may stall the transition. As a result of coronavirus disease 2019 (COVID-19), CMS announced it would stop accepting applications for new accountable care organizations in 2021.

 (NAACOS) is still pushing forward. The organization is supporting new legislation in the House of Representatives that would update Medicare’s ACO program and reward participating ACOs.

Allison Brennan, MPP, senior vice president of government affairs at NAACOS, discusses the new Value in Health Care Act, how other policy changes at CMS have impacted ACOs, and the effect COVID-19 has had on ACOs.

Listen above or through one of these podcast services:

National Association of ACOs (NAACOS)

Allison Brennan, MPP, discusses legislation that would affect accountable care organizations (ACOs), the impact coronavirus disease 2019 had on ACOs, and the fall National Association of ACOs meeting. 

NAACOS Continues Pushing Forward on the Transition to Value-Based Care

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. They’re doing this through the Physician-Focused Payment Model Technical Advisory Committee, or PTAC, which was created by the Medicare Access and CHIP Reauthorization Act of 2015.

 analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.

Physician-Initiated Payment Reform: A New Path Toward Value

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care® analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs.

Examining Physician-Initiated Alternative Payment Models, a New Wave of Payment Reform

The federal government has been releasing a number of policies and proposals that will affect care delivery and are aimed at rising costs of care and prescription drugs.

Ted Okon, executive director of the Community Oncology Alliance (COA), sat down with Managed Care Cast to discuss a number of policies affecting COA’s members, including proposals around chimeric antigen receptor T-cell therapies, pharmacy benefit managers, and the Oncology Care Model.

You may need to log in to the website to access this podcast.

CMS Proposes That Patients Be Enrolled in Studies to Get Coverage for CAR T-Cell Therapy

Ted Okon on Policy Priorities for COA in 2019

COA's OCM 2.0: Moving Toward a Universal Payment Model

More Than 300 Groups Seek Halt to CMS' Plans for Global Drug Pricing Index

Trump Proposes Allowing Medicare to Base Drug Prices on What Other Countries Pay

HHS Proposes to End Drug Rebates in Medicare, Medicaid Managed Care

Read more about the stories in this podcast:

Impact of Government Policies and Proposals on Community Oncologists

Practices participating in the Oncology Care Model now have results back from 2 performance periods and are enrolling in performance period 6. With more than 2 years of experience under the model, some practices have found success while others struggle to improve. And with considerable lag time between the end of a performance period and the release of the full report, practices find themselves struggling to quickly pinpoint areas of improvement.

In this podcast, we speak with 2 experts to discuss results from Performance Period 2, and get insight into the successes, challenges, and lessons learned under the OCM, thus far.

OCM Performance Period One Initial Reconciliation

Cautious Optimism: OCM Participants Seem to Have Improved in Performance Period 2

Feedback on the Direction, Challenges of the OCM

Implications of OCM Reports and the Future of the Program

Delay in Performance Period Results Challenges Practices Participating in OCM

In this podcast, we speak with 2 experts to discuss results from Performance Period 2, and get insight into the successes, challenges, and lessons learned under the Oncology Care Model (OCM), thus far.

Two Years Into OCM: Successes, Challenges, and Lessons Learned

Under the Oncology Care Model (OCM) providers have tried to identify service categories that offer the greatest potential for reducing costs during a treatment episode. A 

 estimated standardized episode-level spending for a patient across subcategories of care for each hospital referral region—defined by the Dartmouth Atlas&mdash;in order to identify the greatest opportunities for cost savings.

We spoke with James Baumgardner, PhD, senior research analyst, Precision Health Economics, and lead author of the study, to discuss the findings and their implications.

Cost Variation and Savings Opportunities in the Oncology Care Model

A study published in this month's issue of The American Journal of Managed Care® estimated standardized episode-level spending for patients across subcategories of care for each hospital referral region&mdash;defined by the Dartmouth Atlas&mdash;in order to identify the greatest opportunities for cost savings under the Oncology Care Model (OCM).

Using Cost Variation to Identify Savings Opportunities Under the OCM

 recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included research that showed cancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available.

Cancer Surpasses CVD as Leading Cause of Death in High-Income Counties

Azar Announces Mandatory Oncology Payment Model Is Coming

HHS Lifting IMD Exclusion for Medicaid Payment for Inpatient Mental Health Treatment

Gallup-Sharecare Report Shows How Diabetes Ranks Grew Across the US

The American Journal of Managed Care—November 2018

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Podcast: This Week in Managed Care—Cancer Is the New Leading Cause of Death and Other Health News

Recently, Barbara McAneny, MD, the current president of the American Medical Association (AMA), visited 

)’s office for a wide-ranging discussion on new payment models, transforming care, and the work of the AMA.

McAneny is an oncologist who has been at the forefront of transforming care for patients with cancer. In 2012 she and her organization, Innovative Oncology Business Solutions, received a $19.76 million grant by the Center for Medicare and Medicaid Innovation to develop a community oncology medical home model. The model was implemented in 7 practices and aimed to improve patient care, outcomes, and satisfaction, while reducing costs.

She will be the keynote speaker November 16 in Philadelphia at Patient-Centered Oncology Care

’s annual multistakeholder meeting featuring payers, providers, and patient advocates.

The Future of Oncology? COME HOME, the Oncology Medical Home

AMA Chooses Oncologist Dr Barbara McAneny to Lead as President-Elect

The Price of Innovation When Improving Cancer Care Delivery

Recently, Barbara McAneny, MD, the current president of the American Medical Association (AMA), visited The American Journal of Managed Care®’s office for a wide-ranging discussion on new payment models, transforming care, and the work of the AMA.

Dr Barbara McAneny Discusses New Payment Models, Transforming Care, and the AMA

This week, the top managed care news included the Trump administration giving governors the power to overhaul section 1332 waivers under the Affordable Care Act (ACA); CMS disclosed a breach in the portal that agents and brokers use to assist consumers signing up for health coverage under the ACA; about one-third of all US healthcare payments in 2017 were tied to alternative payment models.

Trump Administration Gives States More Power to Alter ACA Exchange Offerings

CMS Reports Data Breach in ACA Agent and Broker Portal

CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year

Payments Are Increasingly Tied to Value, but More Risk-Based Models Needed

Drug Market to See More Competition, Launch of Biosimilars in 2019

The Academy of Managed Care Pharmacy Nexus 2018

Dr Barbara McAneny Discusses the Effect of OCM's Second Performance Period Results

Podcast: This Week in Managed Care—States Gain Power to Alter ACA Offerings and Other Health News

CMS’ accountable care organization (ACO) program, the Medicare Shared Savings Program, could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs, the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment.

In this episode of Managed Care Cast, stakeholders at ACOs and policy experts discuss the proposed changes and their potential impact on ACO participation.

CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs

Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers

CMS Proposal Is a Start for Making Risk More Appealing to ACOs

MSSP Proposal Better Measures Risk With Changes to the Benchmark Methodology

MSSP Changes Present Opportunities, but Likely to Decrease Number of ACOs, NAACOS Says

Physician ACOs Associated With Growing MSSP Savings Over 3 Years

CMS’ accountable care organization program, the Medicare Shared Savings Program (MSSP), could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs (NAACOS), the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment.

Heard at NAACOS: Focus on Proposed MSSP Changes

This week, the top managed care stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms  the value of daily aspirin for patients with diabetes.

Next Generation ACO Model Saves $62 Million in First Year

Patient, Provider Groups Tell CMS Proposed E/M Service Cuts Will Hurt Sickest Patients

ASCEND Results Confirm Aspirin Prevents Primary Vascular Events in Diabetes

Senate Moves Forward With Drug Price Transparency Amendment

The Financial Impact of the Sequester Cut to Medicare Part B Drug Reimbursement in Community Oncology

Podcast: This Week in Managed Care&mdash;Next Gen ACO Success and Other Health News

The renewal for the ninth straight year includes McKesson's latest measure for resolution of health-related social needs.

Once Again, CMS Selects McKesson’s Practice Insights as a Qualified Clinical Data Registry

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

Alternative Payment Models

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