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Spotlight on ACOs

November 27, 2012 | Daily News

CMS on Nov. 20 sent Medicaid directors guidance on the essential health benefits that states must offer to residents who are newly eligible for Medicaid, and, for the most part, the regulations that apply to private insurance sold in the exchanges will apply to Medicaid, but CMS nevertheless will soon propose a separate regulation on Medicaid essential health benefits.

November 13, 2012 | Daily News

A number of innovation programs under CMMI will be expanded in the near future, CMMI Director Richard Gilfillan told members of the National Business Coalition on Health Tuesday (Nov. 13), as the agency moves forward testing new models of delivery system reform.

October 17, 2012 | Daily News

CMS Innovation Center head Richard Gilfillan says federal officials this week began discussing with providers 48 episodes of care that CMMI is proposing be a part of its bundled payment initiative, which seeks to transition providers away from fee-for-service reimbursement in Medicare but was dealt at least a temporary setback after CMS recently decided to suspend implementation of one of the initiative’s models.

October 15, 2012 | Daily News

Children's hospital representatives are in the early stages of talking to some states interested in expanding medical home programs, and one option might include CMS paying a greater federal match to states to fund health homes for the first two years to set up infrastructure, said Aimee Ossman, director of policy analysis at the National Association of Children's Hospitals.

September 20, 2012 | Daily News

The Bipartisan Policy Center is gathering claims data and other information on new approaches to health care payment and delivery in the public and private sectors as part of a year-long effort to craft proposals to contain costs and improve quality, and a report released by the group Thursday (Sept. 20) lays the groundwork for the upcoming cost-containment recommendations by listing reasons for the country’s overspending on health care that span from fee-for-service pay models to overuse of medical technology and medical malpractice costs.

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.

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