Creating APMs for Specialty Care: A Provider-Led Initiative for Delivering Value
The experiences of a large urology group practice can provide finance leaders with insight into key considerations involved with developing an advanced alternative payment model (APM) for a healthcare specialty area.
MA Ruling May Signal Industry Readiness to Integrate SDH into Traditional Medical Care
In addressing social determinants of health and social services, a recent Medicare Advantage ruling by CMS may have taken the first steps toward providing more integrated and comprehensive care to the nation’s aging population.
Value: The Way Forward
Value-based payment won’t bend the cost curve unless healthcare organizations commit to fundamental change. Not everyone will come out whole.
The Current Outlook for Value-Based Care Under the Trump Administration
Value initiatives introduced by the Affordable Care Act have met with varied success. Under the Trump administration, the future of these initiatives is uncertain.
Latest ACO Trends Identified
April 20—Although private accountable care organizations (ACOs) appear to be gaining ground, the Medicare versions are still leading—amid challenges.
New MA Rules Benefit Provider-Sponsored Plans
April 18—Recently announced Medicare Advantage (MA) rates and rule changes could help sometimes-struggling provider-sponsored plans improve their performance.
Ask the Experts: Cost Sharing Programs
I am looking for more information about how to manage patients covered by cost sharing programs.
Confirming Eligibility of ACA Medicaid Enrollees ‘Top Priority’ of Administration
April 13—Amid a recent finding that three states spent more than $1 billion on enrolling ineligible Medicaid beneficiaries, the Trump administration is prioritizing the verification of eligibility among the 11 million who were added to the Medicaid rolls through healthcare reform.
Ask the Experts: CJR Physician Gain Sharing Agreements
Are boilerplate CJR physician gain sharing agreement templates available or should agreements be created from scratch?
Are ACOs Saving Medicare Money?
April 10—Whether accountable care organizations (ACOs) save money for Medicare has emerged as a key question because it could determine how hard regulators push participating providers to take on downside risk.