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ACO Initiatives Test Pharma's Traditional Sales Model
The US healthcare system's shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government—led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
The US healthcare system’s shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government—led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
About 10% of the US population, or 34 million people, will be enrolled in either government-funded or commercial ACOs by 2015, according to consultants, up from 12 million in 2013. While the numbers are small some estimate that, for a variety of reasons, ACOs’ influence is much greater, with up to 170 million covered lives in the US affected either indirectly or directly.
The Centers for Medicare and Medicaid Services (CMS) established the ACO initiative, which essentially aim to improve coordination and management of patients while lowering the cost of care. Key to their effectiveness are financial rewards for meeting or exceeding pre-determined quality and cost metrics—or, in some models, penalties for falling short. The degree to which providers have a stake in the game and the kinds of goals they must meet vary depending on the model they follow and whether the organization is aligned with the CMS or a private insurer.
Read the full story here: http://onforb.es/T9AicW
Source: Forbes
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
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