Accountable Care Organization Reimbursement and Gain Sharing includes the agreed-upon approach to paying the ACO and its participating providers for health care services rendered and bearing risk as well as the approach to allocating revenues and bottom-line gains to participating stakeholders.
There are many good people at the CMS Innovation Center (CMMI). They mean well. They are our friends. But friends need to call out friends when they are out of line. I received an email this morning from CMS announcing the launch of their new “Value-Based Care Spotlight” website. Right near the top of the
This month, disappointing evaluation results call for re-thinking of our approach to improving specialty care. Nancy Keating and 12 of her colleagues from multiple medical schools and consultancies working with the CMS Center for Medicare and Medicaid Innovation (CMMI) published the results of their formal evaluation of the Oncology Care Model (OCM), a three-year large-scale
The Biden administration’s CMS Innovation Center 5-year vision conspicuously lacks mention of what I consider to be necessary course corrections to reverse a disappointing first decade.
What is missing from the CMS Innovation Center five year vision? Read More »
In a recent health policy viewpoint article in JAMA, Drs. Don Berwick and Rick Gilfillan noted that, although the CMS Center for Medicare and Medicaid Innovation (CMMI) has done some good during its ten+ years of existence, it has failed to “become the engine that it could be for transforming the nation’s health care finance
In the June 15, 2017 issue of the New England Journal of Medicine, Andrew Ryan and colleagues from the University of Michigan published an evaluation of the Medicare Hospital Value-Based Purchasing Program (HVBP). To summarize, if you offer a 1% incentive, and then dilute it by offering it only for the 40% of hospital patients
This morning, I read about the recently announced next generation version of the CMS Comprehensive Primary Care model, which will require multi-payer participation and will involve up to 5K practices in 20 regions. Sounds interesting. I need to study it in more detail. But based on my initial assessment: I agree with the idea of
First take on new CMS Comprehensive Primary Care Plus model Read More »
Recently, Jesdeep Bassi and Francis Lau of the University of Victoria (British Columbia) published in the Journal of the American Medical Informatics Association (JAMIA) another in a series of review articles that have been written in recent years to summarize the literature regarding the economic outcomes of investments in health information technology (HIT). Such articles answer
New HIT ROI lit review is a methodologic tour de force, but misses the point Read More »
Trinity Health – Michigan and Blue Cross Blue Shield of Michigan (BCBSM) recently announced that they signed a three and a half year agreement under which BCBSM will provide some funding to support a collaborative effort of Trinity Health and its affiliated physician organizations to make improvements in infrastructure designed to improve clinical integration and support
In a very interesting recent post to the Health Affairs blog, Ken Kaufman challenges the widely repeated assertion that the current low level of health care cost growth can be attributed to the recession. After decades of double digit trend, the rate slowed in recent years down to a mere 3.9% in 2010. The conventional
Yesterday, CMS announced the first batch of 27 “normal” ACOs under its Medicare Shared Savings Program (MSSP). I found five things interesting about the list: 93% were unwilling to accept downside risk. In the original proposed rule for the MSSP, ACOs would have been forced to accept downside risk. Presumably, CMS thought that “skin in
