Archive for Alternative payment models

 

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation.

This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive.

Details about the new policy, including the ACO models that qualify for this exemption and the conditions under which those ACOs can gain exemption from the three-day inpatient stay requirement, can be found in the new CMS guidance document Medicare Shared Savings Program:  SKILLED NURSING FACILITY, 3-DAY RULE WAIVER.…

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations.

The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach.

  • A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending.
  • Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems.
  • Greater flexibility to innovate in exchange for participating in performance-based risk.
  • Permission to offer new incentives to patients to take greater responsibility for their own health.
  • Incorporation of regional spending differences when setting individual ACOs’ target spending and to foster greater alignment with Medicare Advantage programs.

Learn more about CMS’s new Pathways to Success Program for Medicare ACOs by reading this program announcement and the regulation detailing how the ACO program will change.…

APM Use Rising

Alternative payment models now account for more than one-third of health care payments, according to a new analysis.

Leading the way is Medicare Advantage plans, which expend nearly half of their Medicare payments through APMs.

Learn more about this trend in health care delivery and payments in the report “APM Measurement:  Progress of Alternative Payment Models,” which was prepared by the Health Care Payment Learning & Action Network and can be found here.

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Medicaid APMs Moving in New Directions

For the most part, states’ use of alternative payment models in their Medicaid programs so far have focused on the work done by primary and acute-care providers.  Now, a number of states are starting to extend their use of APMs in other areas, including:

  • behavioral health providers
  • safety-net providers
  • long-term care providers

For a look at what states are doing to drive value in Medicaid payments in these new areas, see the Commonwealth Fund article “The Next Generation of Paying for Value in Medicaid,” which can be found here.…