Alternative Payment Models

Value-Based Care Payments May Reach 60% in Next Five Years

by Vera Gruessner

Value-based care payments are quickly becoming a mainstay in today’s health insurance industry with more payers jumping on the bandwagon of bundles, alternative payment models, and accountable...

Payment Reforms in NY Medicaid Program Face Challenges

by Vera Gruessner

The state of New York has been working toward redesigning their Medicaid program and fixing the various problems plaguing this system. In particular, payment reforms within the New York Medicaid...

Coordination, Interoperability Key for MACRA Requirements

by Vera Gruessner

Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful...

NY’s Medicaid Payment Reforms Aim to Reduce Hospital Use

by Vera Gruessner

The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would...

Medicare Must Remain Cautious with Alternative Payment Models

by Vera Gruessner

The federal government has brought a tremendous amount of focus on reforming provider-payer reimbursement in order to reduce the rising healthcare expenditure around the country. New regulations have...

Bundled Payment Models Need to Align Payer, Provider Incentives

by Vera Gruessner

Bundled payment models are growing in popularity throughout the health insurance industry partially due to the Centers for Medicare & Medicaid Services (CMS) pushing forth alternative payment...

Population Health Vital for Alternative Payment Model Success

by Vera Gruessner

The Department of Health and Human Services (HHS) has given the healthcare industry three years to transition toward alternative payment models. HHS Secretary Sylvia Burwell announced last year that,...

Maryland’s All-Payer Model Shows Promising First Year Results

by Vera Gruessner

Last week, the Department of Health and Human Services (HHS) announced the state of Maryland’s first year results from its All-Payer Model. Maryland has implemented a global budget payment system...

CMS Releases Final Rulings for 2016 Healthcare Payment Models

by Vera Gruessner

Last Friday, the Centers for Medicare & Medicaid Services (CMS) announced its issuance of the final rules regarding Medicare payment in 2016 to physicians and healthcare professionals in an effort...

How MACRA Affects Future of Healthcare Payment Models

by Vera Gruessner

Earlier this year, the federal government repealed the Medicare Sustainable Growth Rate (SGR) Formula, which affected the future of healthcare payment models all across the board. Recently, the Centers...

Does Value-based Care Hurt Single Physician Practices?

by Vera Gruessner

The healthcare industry has undergone a variety of reforms in the last several years and this may be leading to workflow difficulties for physicians. From meaningful use requirements and the ICD-10...