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.
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.
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.
Last week, CMS took a significant step in its’ campaign to shift Medicare fee-for-service payments to alternative payment models. CMS proposed the first mandatory bundled payment model – the Comprehensive Care for Joint Replacement Model (CCJR) – which will pay hospitals in 75 markets a bundled payment for hip and knee replacements beginning in 2016. The CCJR bundle includes both the hospitalization and care 90-day post-discharge.
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.
Avalere analyses show that more than 700 ACOs already operate in the U.S.
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 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.
In the payment and delivery reform landscape, bundled payments are emerging as a promising model. Medicare, Medicaid, and commercial payers are adopting bundled acute and post-acute care payments to align cost and quality incentives across an entire episode of care.
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.
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.
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.
As stakeholders across the healthcare spectrum continue to wait for CMS’ ACOs Rule 2.0, Avalere’s Josh Seidman takes a crack at pinpointing the much anticipated ACO policy changes.
With something as complex and as political as shared savings models in healthcare, there will always be push-back. But according to Avalere’s Josh Seidman, now is a unique opportunity for Accountable Care Organizations (ACOs) to finally succeed. Josh explains that the current healthcare infrastructure makes ACOs attainable thanks to recent changes, including increased electronic health record use, more provider comfort with comparative performance reporting, enhanced centrality of patient engagement and new incentives that reward accountability and value.