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Why Healthcare Bundled Payment Models May Expand in 2017

January 9, 2017 - The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized bundled payment model for cardiac and orthopedic care in December 2016. CMS also published a report in September 2016 about the Bundled Payments for Care Improvement (BPCI) program, which shows...


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CMS Halts on Changing Medicare Part B Prescription Guidelines

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The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

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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...

Top Ways Payers Integrate Patient Engagement Strategies

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The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate patient engagement and bring the patients...

CMS Accountable Care Organization Model Targets Dual Eligibles

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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...

Tom Price and His Stance on Value-Based Care Reimbursement

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Representative Tom Price, an orthopedic surgeon, was nominated to be the next Secretary of the Department of Health & Human Services (HHS) on November 29. What does this nomination mean for value-based care reimbursement in the Medicare program?...

CMS Commits to Improved Care Quality, Medical Spending Cuts

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The Centers for Medicare & Medicaid Services (CMS) will continue to work toward creating a better healthcare system for patients while keeping close track of medical spending regardless of which political party is in charge, said Andy...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

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The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

Patients Need More Guidance on Medicare Prescription Drug Plans

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Among Medicare beneficiaries, 34 percent are not taking the time to review their Medicare Advantage prescription drug plan before renewing during the open enrollment period, according to a Walgreens survey. Nearly one in five or 19 percent stated...

CMS Releases Final Rule for Medicare Physician Fee Schedule

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Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

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In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

MACRA Implementation Solutions Payers, Providers Should Follow

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MACRA implementation will take place across the healthcare industry starting next year, as more and more providers begin participating in Advanced Alternative Payment Models (APMs) and and the Merit-Based Incentive Payment System (MIPS). Commercial...

ACO Investment Model May Improve Care Delivery in Rural Areas

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While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some challenges especially in rural areas. When comparing...

Children’s Health Insurance Program Enrollment Expands in Flint

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The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more children in Flint, Michigan will be connected to...

CMS Comprehensive Primary Care Program Gained $57M in Savings

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Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care practices participating in the Comprehensive...

New Leadership at Veterans Affairs Results from Transfers

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One public health payer that has had a wide amount of controversy regarding its operations is Veterans Affairs. The latest controversy comes regarding the Veterans Affairs claim that it has new leadership and leadership teams. USA Today conducted...

How Stakeholder Input on Quality Payment Program Differs

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At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new Quality Payment Program. HHS reiterated in a press...

Six Medicaid ACOs Vary in Consumer Engagement Success

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Consumer engagement in a number of Medicaid accountable care organizations (ACOs) tend to vary significantly, according to a September 2016 report from the Center for Consumer Engagement in Health Innovation. With providers being incentivized...

CMS Unlawfully Paid $9M to Beneficiaries for Medicare Services

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The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014, according to a report from the Department of Health...

CMS Medicare Value-Based Care Model Expands to 3 More States

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The states of Alabama, Michigan, and Texas will be able to test the Medicare Advantage Value-Based Insurance Design model beginning on January 1, 2018, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS). During...

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