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Spotlight on ACOs

August 28, 2012 | Daily News

A survey of hospital participation in accountable care organizations shows that many ACOs are physician-led and the delivery system is evolving toward more preventive, primary and coordinated care, but the results also suggest continued challenges in creating an ACO infrastructure that can take on the financial risk, according to Anne-Marie Audet, chief author of a Commonwealth Fund issue brief on the subject.

August 28, 2012 | Daily News

CMS has given state Medicaid directors details of what CMS expects from Medicaid “integrated care models,” such as accountable care organizations and medical homes, and those instructions include an explanation of what states can do with state plan options without having to resort to waivers.

August 22, 2012 | Daily News

CMS has tapped 500 practices in seven states and regions to participate in a new public-private partnership as part of the Comprehensive Primary Care Initiative, which will include CMS, five state Medicaid agencies, commercial health plans, and self-insured businesses, the agency revealed Wednesday (Aug. 22).

August 06, 2012 | Daily News

The recommendation on the treatment of physician self-referrals put forth by a group of health policy experts convened by the left-leaning Center for American Progress is an indication that Democrats are accepting that self referrals cannot be banned within integrated care organizations, such as accountable care organizations (ACOs), a physician lobbyist says.

August 03, 2012 | Daily News

Minnesota AG Lori Swanson has provided CMS with information and patient affidavits regarding potential EMTALA violations by one of CMS' 32 Pioneer Accountable Care Organizations due to Accretive Health's alleged debt collection activities, as Swanson's office does not have authority to enforce the federal law, according to a statement describing Accretive's settlement with the state.

July 09, 2012 | Daily News

Nearly half of CMS' newly named ACOs are physician-led organizations with fewer than 10,000 beneficiaries and CMS Principal Deputy Administrator Jonathan Blum says the diversity of participants shows that ACOs are transforming how health care is delivered and are not merely the provenance of a few, elite provider organizations.

June 18, 2012 | Daily News

Congress' Medicare advisory board plans to explore policy options to increase care coordination in the Medicare program, according to the MedPAC June report released Friday (June 15), which says the incentives in fee-for-service work at cross purposes with care coordination and interim steps may be needed until payment reforms changing those incentives are fully operational.

June 18, 2012 | Daily News

The American Medical Association says Congress needs to relax anti-fraud laws to entice physicians to broadly enter into new physician-led delivery reform models outside the reform law's Accountable Care Organization program, a view echoed by the Medical Group Management Association.

June 13, 2012 | Daily News

CMS will accept another round of applications for the Advanced Payment Accountable Care Organization Model, designed to attract more provider-based and rural ACOs that might not have the resources to set one up, for organizations that would start the Medicare Shared Savings Program on Jan. 1.

June 07, 2012 | Daily News

Some of the most difficult aspects to setting up accountable care organizations has been giving ACOs sufficient claims data and getting doctors in ACOs to report to a common governance entity, CMS Medicare chief Jon Blum said Thursday (June 7) at the ACO Summit conference in Washington.

June 07, 2012 | Daily News

CareFirst BlueCross BlueShield touted $40 million in savings generated by 151 panels in Patient-Centered Medical Homes during the first of the multi-year program, and CareFirst President Chet Burrell said within the next few years he expects the program to bend the cost curve by 3-5 percent cumulatively by reducing admissions, re-admissions and emergency room visits for high-risk patients.

June 07, 2012 | Daily News

Changing financial alignments as part of delivery system reforms has provided private sector stakeholders with on the ground experience about how moving out of a pay-for-volume model drives a more collaborative culture, and public sector stakeholders in Oregon say their pilot program has shown similar results.

June 06, 2012 | Daily News

CMS revealed Wednesday that 45 payers -- including several major private insurers and five state Medicaid programs -- will participate in the multi-payer Comprehensive Primary Care Initiative that gives primary care practices additional payments to bolster the care they provide.

April 11, 2012 | Daily News

An upstate New York medical group with close ties to freshman GOP Rep. Nan Hayworth, a vocal opponent of the health law who was elected during the Tea Party wave of 2010, is one of the 27 organizations that CMS selected to participate this week in Medicare's accountable care organization program. Hayworth, an ophthalmologist, was a former partner at Mount Kisco Medical Group, and her husband, Scott Hayworth, is currently the medical group's CEO.

April 11, 2012 | Daily News

Of the 27 ACOs that CMS announced on Tuesday (April 10), only two chose the model that penalizes accountable care organizations for not meeting cost and quality measures in exchange for bigger bonuses when they do achieve those benchmarks. CMS Medicare chief Jonathan Blum said the ACO program is off to a “phenomenal start,” but ACO consultants said the lack of interest in the two-sided risk model shows that it could have been a disaster if CMS had stuck to its original plan to force that approach on all ACOs.

March 26, 2012 | Daily News

It looks as if many of the states that planned to take part in the “duals” demonstration, which aligns payment between Medicare and Medicaid for residents covered by both of those programs, will have to sit out the demo because they cannot meet the deadlines, sources tracking the demo say. States that plan to participate must post their proposals on state websites for public comment within the next couple of weeks in order to meet their deadlines for submitting those proposals to CMS, and most have not.

March 10, 2012 | Daily News

A CMS official speaking at the National Association of State Health Cooperatives (NASCHO) suggested that accountable care organizations (ACO) would make good partners for the new Consumer Oriented and Operated Plans (CO-OPs), which were established under the health law as non-profit competitors to insurers. Barbara Smith, the agency's key point person for the CO-OPs, told the audience of interested stakeholders that ACOs present an opportunity because many are looking for organizations who could step in and help bear some of the risk.

March 08, 2012 | Daily News

CMS asked all Pioneer Accountable Care Organization participants to review their provider lists and submit a final, correct list to the agency by mid-February following an incident in which two California participants sent letters to Medicare patients of several providers who had not agreed to join the ACO, according to documents obtained by Inside Health Policy.

January 23, 2012 | Daily News

Multi-specialty medical groups are urging congressional conferees to hammer out a longer-term Medicare physician payment solution that takes physician practice costs into account and rewards providers for delivering quality care. As conferees prepared to launch talks Tuesday (Jan. 24), the American Medical Group Association (AMGA) asked lawmakers to reject additional short-term fixes, warning a continued threat of payment cuts could thwart health reforms such as accountable care organizations and physician quality efforts.

January 19, 2012 | Daily News

On the same day that Premier announced its QUEST initiative saved more than 24,000 lives and nearly $4.5 billion over three years, the Congressional Budget Office said Medicare demonstrations that build on the kind of data sharing and medical-practices development engendered by QUEST showed no evidence of reducing Medicare spending.