Farzad Mostashari, M.D.: The MSSP Is Absolutely Proving Itself

Healthcare Innovation | November 5, 2024

Many healthcare leaders were elated when officials at the Centers for Medicare & Medicaid Services (CMS) on October 29 released the 2023 calendar-year results for the Medicare Shared Savings Program (MSSP), the program run by the Medicare program with the largest number of participating accountable care organizations (ACOs). As the press release from CMS on that date stated, “The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program (Shared Savings Program) continues to save Medicare money while supporting high-quality care. The Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the Shared Savings Program’s history. In addition, Shared Savings Program Accountable Care Organizations (ACOs) are providing higher-quality care and supporting policies CMS has adopted to enhance primary care, expand access to accountable care to underserved communities, and prioritize quality care for common chronic conditions.”

Why Accurate Provider Data Can No Longer Be Overlooked in Value-Based Care

Health IT Answers | November 6, 2024

In Spring 2023, AMA President Dr. Jack Resneck, Jr. sat before the Senate Finance Committee and discussed the critical state of physician directories, which are, by all accounts, riddled with inaccurate data. To demonstrate, on the morning of the hearing, the committee’s chair, Senator Ron Wyden, released the results of a study in which phone calls were made to 120 provider listings across 12 different health plans. The data revealed that 33% of those listings were inaccurate, had nonworking numbers, or had unreturned calls. In his testimony, Dr. Resneck noted, “Imagine selecting a health plan and paying health insurance premiums only to find out that you relied on erroneous information. Imagine the sense of helplessness and frustration amongst patients when they cannot access the care on which they were counting.” A recent study that discovered inaccuracies in 80% of entries in the nation’s five largest health networks’ directories puts the issue’s scope into perspective.

How Hospices Can Leverage Palliative Care to ‘Stay Relevant’ in Value-Based Care

Hospice News | November 6, 2024

U.S. health care is moving steadily towards value-based reimbursement, and having a robust palliative care program can help hospices ensure they are not left behind. The U.S. Centers for Medicare & Medicaid Services (CMS) is working to ensure that 100% of Medicare beneficiaries are aligned with a risk-based payment model by 2030. This can include Medicare Advantage (MA) and Accountable Care Organization (ACO) programs. With hospice reimbursement confined to the traditional Medicare benefit, a palliative care program is a likely entry point for those providers to access value-based reimbursement, Sue Lynn Schramm, a partner of the hospice and palliative care consulting company Confidis LLC, said in a presentation at the National Hospice and Palliative Care Organization Annual Leadership Conference.

Your ACO May Already Be Late For APP Reporting. Here’s How To Catch Up!

Roji Health Intelligence | November 5, 2024

With one year remaining before mandatory APP Reporting in 2026, the idea that you’re already late may sound exaggerated. But consider the significance of what you’re undertaking: This is your first effort to report quality on all your beneficiaries, not just a tiny sliver of patients. It’s a huge leap that requires a lot of advance work. Throughout the 2025 Performance Year data for reporting in 2026, you will be accumulating measure data—or not. You have no chance to improve your quality metrics once 2025 is closed. For your ACO to be ready for APP Reporting in 2026, you must make and implement numerous decisions and strategies, starting with aggregation of data. These require a series of steps, then tests, to put you at the starting line. Let’s see if your ACO is running late. Here are the signs that you are not well-positioned for APP Reporting and still have a lot to do...