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Alternative Payment Models

APMs, Health Data Exchange among Top Payer Reform Goals

March 22, 2017 - The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient outcomes. The report outlines four priorities that involve designing value-based reimbursement models, improving caregiver and patient engagement,...


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APMs, Health Data Exchange among Top Payer Reform Goals

by Thomas Beaton

The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

Doctors Provide 5 Alternative Payment Model Improvements

by Thomas Beaton

A journal article published in the American Journal of Managed Care, outlines recommendations from several doctors on significant ways alternative payment models (APMs) can be improved and better designed. APMs are being promoted throughout the...

CMS Seeking Feedback on Pediatric Alternative Payment Model

by Thomas Beaton

The Centers for Medicare & Medicaid Services (CMS) recently issued a request for information seeking input on designing an alternative payment model focused on improving care quality and cost (APM) that specializes in pediatric care. The...

Social Determinant Data Key to Successful Risk-Based Contracts

by Jacqueline Belliveau

From bundled payment models to capitated healthcare payments, payers implement risk contracts to financially motivate providers to target high-cost and high-utilization patient populations to reduce overall healthcare costs. But increasing payer...

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...

Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number...

Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement

by Vera Gruessner

  In recent years, the national health payer Anthem has been advancing value-based care reimbursement by collaborating with primary care providers and operating the Enhanced Personal Health Care program, according to a report released...

Stakeholders Offer Key Principles for Alternative Payment Models

by Vera Gruessner

More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and hindrances...

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...

20% of Surveyed Physicians Familiar with MACRA Regulations

by Vera Gruessner

No more than 20.6 percent of primary care physicians and 19.5 percent of specialists are “very or somewhat familiar” with MACRA regulations, according to a survey completed in 2016 by Merritt Hawkins for The Physicians Foundation....

Medical Organizations Advise Changes for Quality Payment Program

by Vera Gruessner

The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30 medical groups were concerned about MACRA regulations...

70% of Medical Groups Concerned About MACRA Regulations

by Vera Gruessner

MACRA regulations have impacted the revenue cycle of providers across the country particularly regarding Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). The American Academy of Family Physicians outlined how...

5 Solutions for Conquering Challenges of Bundled Payment Models

by Vera Gruessner

Despite strong optimism and stakeholder enthusiasm, a new bundled payment program operated by the Integrated Healthcare Association and the RAND Corporation faced major problems and delays. A report from the Agency for Healthcare Research and...

Communication Key for Transition to Alternative Payment Models

by Vera Gruessner

Along with health insurers, more and more providers are expected to transition to alternative payment models (APMs) especially due to MACRA’s Quality Payment Program. For example, urology group practices are likely to adopt advanced alternative...

How Payers Could Gain Success in Value-Based Care Models

by Vera Gruessner

Value-based care models are on their way to becoming the main form of reimbursement between payers and providers especially when considering the goals of the Centers for Medicare & Medicaid Services (CMS) to position 50 percent of Medicare...

Payers Benefit from Aligning with MIPS, Value-Based Care

by Vera Gruessner

While healthcare regulations like MACRA legislation often centers around impacting medical providers, the health insurance industry is also integrated into the tapestry of value-based care and alternative payment models. When providers start...

How to Fix Obama’s Affordable Care Act Without a Repeal

by Vera Gruessner

Now that a new President and a Republican-controlled Congress has been elected, what does the future for healthcare reform and the Affordable Care Act (ACA) look like? What will happen to the Affordable Care Act cannot be answered simply since...

Premier Accountable Care Organizations Improved Quality in 2015

by Vera Gruessner

New results from the Premier Inc. Population Health Management Collaborative (PHMC) show that accountable care organizations (ACOs) within the collaborative improved quality and cost reduction in 2015 better than other ACOs operating through...

How to Favorably Manage Risk in Value-Based Care Reimbursement

by Vera Gruessner

While downside risk does not incentivize providers to take part in value-based care reimbursement policies, data-driven technology and a combination of financial motivations may encourage physicians to transition to alternative payment models,...

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