Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Accountable Care Organizations

CMS Solicits Payer Participation to Next Phase of CPC+

February 23, 2017 - In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative payment model (APM). Eligible clinicians in the Quality Payment Program can avoid negative Medicare payment adjustment and potentially receive...


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CMS Solicits Payer Participation to Next Phase of CPC+

by Thomas Beaton

In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative...

Two-Sided Financial Risk Model Reduces Socioeconomic Disparities

by Thomas Beaton

A two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. Disadvantaged patients receiving...

State Medicaid Programs Invest in Accountable Care Organizations

by Vera Gruessner

Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are 10 states that are managing Medicaid ACO programs...

Should Accountable Care Organizations Include Social Services?

by Vera Gruessner

While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according...

How CMS Alternative Payment Programs Impact Healthcare

by Vera Gruessner

Over the last five years, the Centers for the Medicare & Medicaid Services (CMS) has released many new payment systems for Medicare providers including shared savings, pay-for-performance programs, and bundled payment models. The alternative...

Highmark Partners with Aledade’s Accountable Care Organizations

by Vera Gruessner

In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical treatment through accountable care organizations....

UnitedHealthcare Partners with Accountable Care Organizations

by Vera Gruessner

In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members...

Top 3 Reasons to Partner with Accountable Care Organizations

by Vera Gruessner

With value-based care reimbursement becoming the standard across health insurance companies and medical facilities around the country, stakeholders are investing more time and resources in accountable care organizations (ACOs). Why should healthcare...

How 3 Healthcare Insurers Expand Value-Based Care Payment

by Vera Gruessner

National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based...

5 Best Practices to Advance Value-Based Care Reimbursement

by Vera Gruessner

When payers begin to transition to value-based care reimbursement from the more traditional fee-for-service payment system, company executives and financial experts may find it takes longer than expected to adopt the new payment structures while...

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

by Vera Gruessner

Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

Accountable Care Organizations May Improve Diabetes Management

by Vera Gruessner

Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American...

Population Health Management Helps ACOs Earn Shared Savings

by Vera Gruessner

Continually rising medical costs without significant benefits to patient care have led both public and private payers to invest in value-based care payment structures such as accountable care organizations (ACOs). However, when payers and providers...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

MACRA Pushes Payers to Adopt Value-Based Care Payment Models

by Vera Gruessner

This past summer, the Labor Department announced that healthcare spending rose in August more steeply than at any point in more than 30 years. The costs for medical treatment grew by 1 percent in just one month, the Los Angeles Times reported....

UnitedHealth Releases Accountable Care Organization Coverage

by Vera Gruessner

On December 7, UnitedHealthcare announced in a company press release the introduction of the NexusACO, which is a new health plan product that allows consumers to obtain care from accountable care organizations. The program is expected to reduce...

CMS Accountable Care Organization Model Targets Dual Eligibles

by Vera Gruessner

On December 15, the Department of Health & Human Services (HHS) announced the creation of the new Medicare-Medicaid Accountable Care Organization (ACO) Model. The model is meant to improve the quality of care and decrease costs of beneficiaries...

Top 10 Healthcare Insurance Headlines from 2016 Involve Value

by Vera Gruessner

Over the last year, the medical insurance industry has undergone a variety of changes and overcame challenges as the space transitioned to value-based care. Below we outline ten of the most influential healthcare insurance headlines from 2016...

UnitedHealthcare Cut Costs through Value-Based Care Programs

by Vera Gruessner

Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

UnitedHealth Adopts Bundled Payment Model for Orthopedic Care

by Vera Gruessner

Healthcare payers are finding that their reimbursement totals show higher spend for hip, knee, and spine surgeries and other orthopedic care when compared to other forms of treatment. Along with the higher spend, members regularly show poor health...

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