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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.

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.

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.

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.

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.

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.

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