Alternative Payment Models

The proposed risk adjustment changes to the Medicare Shared Savings Program (MSSP) are welcome but moving accountable care organizations (ACOs) to risk too soon could harm the program, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Approximately one-third of all US healthcare payments in 2017 were tied to alternative payment models, with the remaining still tied to fee for service. The findings of the Health Care Payment Learning and Action Network report highlighted that even as payments move to value-based models, more spending in models with risk is needed.

Accountable care organizations (ACOs) in the Medicare Shared Savings Program vary considerably in how they treat men with newly diagnosed prostate cancer, according to a study that assessed whether the level of engagement in ACOs by urologists could affect rates of treatment, overtreatment, and spending in prostate cancer care.

The push to get accountable care organizations to take on risk faster could lead to more participation in Medicare Advantage, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.

CMS’ proposed changes to the Medicare Shared Savings Program (MSSP) doesn’t represent a major shift in policy stance toward accountable care organizations (ACOs), said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

Piecemeal solutions to implement value-based payment arrangements will not be able to effectively enact change. Authors in The New England Journal of Medicine argue that a range of complementary solutions need to be pursued simultaneously based on previously successful tactics on a smaller scale.

Finding a place for value-based payment with the fast paced innovation in oncology.

By encouraging more providers to take on risk faster, the current administration may actually be disincentivizing providers from participating at all, which would reduce the number of accountable care organizations (ACOs), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

Private payers are getting more engaged in accountable care organizations (ACOs), said Clif Gaus, ScD, president and CEO of the National Association of ACOs.

Accountable care organizations (ACOs) have not had a significant impact on cancer care costs and utilization. While cancer care costs did decline from before the introduction of ACOs to after, there was no significant difference in spending decreases between ACO practices and non-ACO practices caring for patients with cancer.

The proposed changes to the Medicare Shared Savings Program that move accountable care organizations (ACOs) to take on risk in just 2 years is not going to be enough time for most ACOs, although some may be ready in that time, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Practices in the US Oncology Network received an average positive payment adjustment under the Merit-based Incentive Payment System (MIPS) of 1.90% for performance in 2017, and 99% of the Network’s physicians were in the top tier of performers. The maximum allowable adjustment is 2.02%. The adjustment based on a clinician’s performance in 2017 impacts the clinician's Medicare reimbursement for 2019.

Contracts for accountable care organizations (ACOs) can be very different depending on who the payer is, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.

At the National Association of ACOs Fall 2018 conference, private payers discussed how they are working with accountable care organizations (ACOs) to create new opportunities in the commercial market.

During the opening plenary and panel at the fall 2018 meeting of the National Association of ACOs (NAACOS), Adam Boehler, of the Center for Medicare and Medicaid Innovation, highlighted the fact that CMS has to provide predictability and simplicity to get more accountable care organizations to take on risk and succeed, but that those who are not "cutting it" should "get out of the way" for others.

Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System, discusses how Mount Sinai’s accountable care organizations (ACOs) will have to adjust to the proposed CMS Medicare Shared Savings Program (MSSP) changes.

Accountable care organizations (ACOs) are of 2 minds right now. On the one hand, there is a lot of excitement for the future of ACOs, but there is also great anxiety around the changes that CMS proposed for the Medicare Shared Savings Program (MSSP), said Clif Gaus, ScD, president and CEO of the National Association of ACOs (NAACOS).

The type of cancer a provider treats can determine how well he or she performs under the Oncology Care Model (OCM), according to research from Avalere Health that was presented at the American Society of Clinical Oncology Quality Care Symposium.

The proposed CMS regulation to change the Medicare Shared Savings Program (MSSP) so that accountable care organizations (ACOs) take on risk faster creates a one-size-fits-all model that doesn’t allow for variability, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

The Institute for Value-Based Medicine travels to New York City to learn how technology and trust are key to making the leap to two-sided risk.

Not only do physician-group accountable care organizations (ACOs) save Medicare more money than hospital-integrated ACOs, but the savings of physician ACOs grew substantially over 3 years.

Since they foot the bill for a lot of Americans’ healthcare costs, employers have a lot vested in the health of their populations and have been involved with pushing for healthcare transformation, said Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform.

CMS’ proposed rule described strong financial results from low-revenue ACOs, as well as ACOs in risk-bearing tracks, but it mostly ignored the success of small, rural providers in ACOs.

With cancer costs rising and patients with cancer disproportionately facing financial toxicity, alternative payment and care delivery models are thought to help alleviate some of the cost burden. However, a review finds limited evidence available to evaluate the efficacy of alternative payment and care models in cancer care.

CMS' Medicare Shared Savings Program proposal would make substantial changes to the benchmarking methodology for accountable care organizations.

A new report contradicts CMS’ claim that the Medicare Shared Savings Program increased Medicare spending by $344 million from 2013 to 2015. The new analysis finds that accountable care organizations (ACOs) actually reduced federal spending by $542 million after accounting for shared savings payments earned.

A National Comprehensive Cancer Network (NCCN) working group dedicated to analyzing current challenges under existing policy and treatment paradigms presented their findings and recommendations at an NCCN Policy Summit in Washington, DC.

As the term “value” has become a norm in healthcare, specifically in oncology, panelists at a National Comprehensive Cancer Network policy summit offered perspectives on where we are now in delivering high-quality cancer care under value-based payment models.

An early review of the second performance period of the Oncology Care Model (OCM) seems to show improvements over the first period.

Over 14,600 comments poured into CMS to meet a deadline to comment about proposed changes to its 2019 physician fee schedule for Medicare, with many physician organizations and individuals asking the agency to halt or slow down its plans to cut physician reimbursement for evaluation and management services. While some groups cheered some of the changes—such as broader coverage for telehealth and other digital monitoring—most expressed many concerns.