Alternative Payment Models

Cost of Cancer Care Reaches Nearly $150B Nationally

by Samantha McGrail

Price tags of life-saving treatments are continuing to increase, with nearly $150 billion being spent nationally per year for cancer care, four times more than treatment for other common health...

CA Judge: No Proof Dialysis Providers Steer Patients to Payers

by Kelsey Waddill

A judge blocked a California bill, AB 290, that would prevent dialysis providers from encouraging end-stage renal disease (ESRD) patients to select health plans that some say offer dialysis providers...

CMS Finalizes Home Health PPS, Expands Infusion Medicare Benefits

by Kelsey Waddill

CMS has announced the finalization of changes to the home health payment model, known as the home health prospective payment system (HH PPS), which includes a home infusion benefit and offers an...

91% of Payers Foresee Alternative Payment Model Activity Increase

by Kelsey Waddill

An overwhelming 91 percent of payers think that alternative payment model (APM) activity will increase in the future, according to a recent survey conducted by Health Care Payment Learning and Action...

CMS Considers AI and Value-Based Care Fraud Prevention Strategies

by Kelsey Waddill

CMS sent out two requests for information, one on program integrity issues regarding the fee-for-service to value-based care transition and the other on how to evolve data analytics and artificial...

Medicaid Spend Grows 2.9% in FY 2019, Medicaid Enrollment Flat

by Kelsey Waddill

Overall Medicaid spending growth was at 2.9 percent for fiscal year (FY) 2019 but is projected to trend upward in the new year, while Medicaid enrollment growth was flat and will continue to be so in...

Alternative Payment Models Rein in State Prescription Drug Spending

by Kelsey Waddill

As Medicaid programs look to provide costly gene therapies, specialty drugs, and other potentially life-saving medications to beneficiaries, states are getting creative by implementing alternative...

Humana Expands Bundled Payment Models for Spinal, Joint Surgeries

by Kelsey Waddill

Humana recently expanded its value-based payment models by signing four more agreements with providers for bundled payment models for spinal fusion surgeries. The payer also announced the growth of...

CMS Proposes Alternative Payment Models for Chronic Kidney Disease

by Kelsey Waddill

CMS recently proposed five alternative payment models for chronic kidney disease (CKD) treatments. One model is mandatory and the others are optional. All of the models are in response to the...

CMS OKs Subscription Model in LA to Lower Hepatitis C Drug Costs

by Kelsey Waddill

CMS recently approved Louisiana’s subscription model for hepatitis C therapies in Medicaid, which would allow the state to negotiate supplemental rebate agreements from prescription drug...

CMS to Test New Models for Medicare, Medicaid Dual Eligibles

by Jessica Kent

CMS has issued a letter to state Medicaid directors inviting them to test new, integrated care models for individuals dually eligible for Medicare and Medicaid. There are 12 million dual eligible...

ACOs Call for Transparency in CMS Alternative Payment Model Design

by Jessica Kent

The National Association of ACOs (NAACOS) has urged the CMS Innovation Center to improve transparency throughout the process of releasing and updating alternative payment models. “While we...

HHS Launches Emergency Services Payment Model for FFS Medicare

by Jessica Kent

HHS and the CMS Innovation Center have announced a new payment model for emergency and ambulance services that will enable Medicare fee-for-service beneficiaries to receive quality care with lower...

Atrius Health, Blue Cross to Create Alternative Payment Model

by Jessica Kent

Atrius Health and Blue Cross Blue Shield of Massachusetts have partnered to launch an advanced alternative payment model that will deliver a higher quality, more affordable healthcare experience. In...

Cigna Value-Based Care Participation Tops 50%, Saving $600M

by Jennifer Bresnick

Cigna has surpassed its goal of having 50 percent of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018, the payer announced. Between...

Can Payers Reduce Stress of Alternative Payment Models for Physicians?

by Chuck Green

Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by Thomas Beaton

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according...

AMA Promotes Alternative Payment Model for Opioid-Use Disorder

by Thomas Beaton

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have announced plans to promote an alternative payment model to address opioid use disorder. Leaders at...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

by Thomas Beaton

AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a...