Category: Regulatory & Reimbursement

Regulatory and reimbursement issues relating to CMS, ACOs, other risk-bearing organizations.

CMS Finalizes the New Medicare Quality Payment Program

Earlier this month the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advance Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively known as the Quality Payment Program. The new policy is expected to…

Arizona Health System Realizes Big Savings on Home Health Monitoring

The “Care Beyond Walls and Wires” Program, launched by Northern Arizona Healthcare in a partnership with Qualcomm Life, saved an estimated $92,000 per patient, according to data taken of the first 50 patients six months prior to enrollment and six months after enrollment. Of those patients, hospital officials saw hospitalizations drop from 3.26 mean per…

ACOs saved more than $400 Million in 2014

According to new data released by CMS,  20 ACOs in the Pioneer ACO model and 333 Medicare Shared Savings Program ACOs saved over $411 million in 2014. Additionally, 97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards alongside savings thresholds. However, a significant number of ACOs still fall short of…

Report Analyzes Variation in Narrow Networks by State in ACA Marketplace

A new report funded by the Robert Wood Johnson Foundation provides a state-by-state analysis of how much choice consumers that purchased health insurance through the ACA marketplace actually have regarding the physician they see. In four states, at least three in four marketplace plans have narrow networks that cover 25 percent or fewer of all area…

Caradigm Health Releases White Paper on ACO Best Practices

Caradigm, a leading population health and health informatics company recently published a white paper on ACO Best Practices for Shared Savings. Memorial Hermann ACO in Houston and the South Texas-based Rio Grande Valley ACO contributed to the list of strategies. Included in these were stratifying managed populations by health risks, like diabetes, and increasing efforts…