Alternative Payment Models
Alternative payment models are becoming more advanced as the government drives to accelerate generated savings. Track and stay ahead of this evolution to identify strategic partnerships and measure results.
Podcast: Lessons from BPCI and Its Implications for CJR
Our experts share the lessons that we’ve learned from our extensive experience with the Bundled Payments for Care Improvement Initiative. The Bundled Payments for Care Improvement demonstration is a voluntary program sponsored by CMMI in which hospitals, physician group practices, and post-acute care providers accept clinical and financial risk for patients over specified episode time frames post-hospital discharge.
Podcast: Setting Up a Gainsharing Agreement in CJR
In order to better coordinate care across the care continuum, CMS is allowing hospitals to establish “CJR Collaborators” or other providers that share risk with the participating hospital. Listen as Fred Bentley and Erica Breese discuss the details.
The Evolving Role of the Center for Medicare and Medicaid Innovation in Achieving Value-Based Payment Goals
The passage of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI) to help advance new payment and delivery models.
Podcast: What Is an APM According to CMS?
The Medicare Access and CHIP Reauthorization Act (MACRA) passed last spring is transforming physician payment and standardizing requirements for APMs. Listen as Adam Borden and Jared Alves cover Advanced APMs, incentives CMS offers for providers to participate in APM, and the exclusion of specific tracks.
Webinar: CJR and Beyond: Excelling in an Era of Mandatory Bundled Payment Models
With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.
Programs Contributing to HHS Meeting Its Alternative Payment Model Goal Largely Consist of Upside-Only Models
HHS confirms continued movement away from traditional FFS payments, yet significant work remains to move more providers away from upside-risk models and into downside-risk models.
Podcast: Avalere’s Take on CJR
Are bundled payments fundamentally changing the way care is provided? Listen in as Fred Bentley, Avalere Center & Payment Delivery Innovation, explains how bundled payment models are spurring clinical innovation and the creation of cross-continuum partnerships.
Sixty Percent of Hospitals Must Reduce Care for Joint Replacement (CJR) Costs Under New Medicare Demo or Face Penalties
Hospitals should focus on care after discharge, which drives more than 39 percent of spending.
Kindred Partners with Avalere and Inovalon to Support Value-Based Payment in Post-Acute Care
Avalere and Inovalon have entered into a multi-year agreement with Kindred Healthcare, Inc., the nation’s largest provider of post-acute care (PAC) services, to deploy the power of data and analytics to engage payers. The combined solutions will result in a data-driven platform that will support Kindred in improving clinical outcomes and promoting coordinated, efficient care under new value-based payment models.
Participation in Risk-Bearing Accountable Care Organizations Triples; CMS Proposes Rule on Medicare Shared Savings Program Benchmark Methodology
The Centers for Medicare & Medicaid Services (CMS) announced that 121 new Medicare Accountable Care Organizations (ACOs) have joined the Medicare Shared Savings Program (MSSP) and Next Generation (Next Gen) ACO models. In addition, 147 MSSP ACOs renewed their contracts. The increase in risk-bearing ACOs and the recently released proposed benchmark rule mark CMS' commitment to shifting from volume to value.
Seasoned Payment and Delivery Expert Joins Avalere
Fred Bentley, an experienced leader in payment and delivery system reform, has joined Avalere’s Center for Payment & Delivery Innovation. Fred will supplement our existing deep expertise in provider strategy and provide analytic and strategic support on issues related to care delivery.
New Analysis Identifies Factors That Can Facilitate Broader Reimbursement of Pharmacist Services
Pharmacists are increasingly providing direct patient care based on each state's scope of practice regulations in a variety of settings spanning inpatient, outpatient, and community pharmacies. Examples of these direct patient care services include immunizations, wellness and prevention screening, medication management, chronic condition management, and patient education and counseling. While opportunities for pharmacists to provide direct patient care services emerge, options for obtaining reimbursement for these services continue to be limited. Avalere Health assessed the current healthcare delivery and payment landscape to identify factors that can facilitate broader reimbursement of pharmacist services.
Avalere’s Josh Seidman Answers Your Questions on the MACRA Request for Information
Recently, CMS released a Request for Information (RFI) inviting public comment on three provisions related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)-the Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and Physician-focused Payment Models (PFPMs). Comments are due to CMS by November 17, 2015. We sat down with Avalere's Josh Seidman to discuss what to expect from the RFI.
The Spectrum of Accountability and Alternative Definitions of Alternative Payment Models
Secretary Burwell set the healthcare community abuzz January 26 when she announced the Department of Health and Human Services' (HHS) plan to set 30 percent of fee-for-service payments to alternative payment models (APMs) by 2016 and 50 percent by 2018.
Patient Engagement: The Do-or-Die of Growing Alternative Payment Models
Avalere analyses show that more than 700 ACOs already operate in the U.S.
Webinar: Tying Payment to Value: Lessons Learned from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract
By the end of 2016, HHS plans to make 30% of fee-for-service payments through alternative payment models, such as accountable care organizations and bundled payments, and tie 85% of all fee-for-service payments to quality or value. This places increasing urgency on healthcare organizations to make a fundamental shift in their approach to care delivery.
Avalere White Paper: A Multi-Stakeholder Vision for Patient-Centeredness in New Payment and Delivery Models
Avalere released its latest white paper on patient-reported outcomes (PROs) today in collaboration with leaders from patient, payer, health information technology, product development and research communities.
HHS Sets Specific Targets and Timelines for Alternative Payment Models and Value-Based Payment
On Monday, January 26, Secretary Burwell announced a goal to have half of Medicare fee-for-service payment in alternative payment models (APMs) by 2018.
Podcast: Volume & Risk in the New Year 2015
As risk shifts, so too does the responsibility for delivering high-quality outcomes at lower costs. In this podcast, listen in as Sally Rodriguez discusses the impact of this shift and the momentum surrounding delivery models. Sally explores what’s ahead for this changing landscape and the opportunities that await.
Podcast: CMS Releases Much-Anticipated Proposed MSSP Rule
The long waiting game for ACO stakeholders is no more after CMS finally released their much-anticipated proposed ACOs Rule 2.0 on December 1, 2014. Listen to Josh Seidman dive into the most recent CMS Medicare Shared Savings Program (MSSP) Rule.