- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Panelists Predict FFS Will Grow More Cumbersome
CMS has attempted to tailor ACOs to meet a variety of needs and levels of risk, depending on where parties are in their knowledge level of payment reform.
Tremendous consolidation of re­maining independent oncology practices is very likely under scenarios painted by panelists at the 4th annual meeting of Patient-Centered Oncology Care, pre­sented by The Ameri­can Journal of Managed Care.
The closing panel discussion of the 2-day event brought together an independent prac­tice representative and a former director of medical policy devel­opment for the FDA. CMS has a strong desire to make accountable care organi­zations (ACOs) work, but there are many variables, and panelists said further ex­perimentation with this form of care could have the effect of driving physi­cians out of fee-for-service (FFS) and into Medicare Advantage, where group health programs administer Medicare payment.
However, the degree to which oncol­ogy practices will participate in this migration is unclear because many of them are falling into the gravitational pull of expanding hospital systems, the panelists said. Yale-New Haven Hospi­tal is an example of a growing, all-en­compassing conglomerate, said partici­pant Ted Okon, executive director of the Community Oncology Alliance (COA): “What’s called Jaws in Connecticut is also known as Yale. They’ve bought up everything in the entire state.”
CMS has attempted to tailor ACOs to a variety of health organizations so that each is comfortable with the level of risk it is undertaking though par­ticipation. The Medicare Access & CHIP Reautho­rization Act, for example, offers the choice of par­ticipation in an alterna­tive payment model or FFS. Similarly, the Oncol­ogy Care Model, scheduled for launch in spring of 2016, allows for innovative forms of reimbursement.
To read the remaining article, please visit OncLive.
Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury
February 21st 2025Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.
Read More
Exploring Racial, Ethnic Disparities in Cancer Care Prior Authorization Decisions
October 24th 2024On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.
Listen
Managed Care Reflections: Insights From Richard J. Gilfillan, MD; and Donald M. Berwick, MD, MPP
February 20th 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The February issue features a retrospective by Richard J. Gilfillan, MD, former director of the Center for Medicare and Medicaid Innovation; and Donald M. Berwick, MD, MPP, former administrator of CMS.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
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.
Listen
