The shift to accountable care and value based payment models is coming. Accountable Care Organizations (ACOs) are just one of the value-based models making waves throughout the healthcare industry. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs. Focusing on shared accountability and quality improvement, ACOs have become champions of the healthcare triple aim. Not to mention a major player in CMS’ plan to tie a large percentage of payments to value by 2017. As ACOs soar in popularity now is the time to weigh your options. Are you are thinking or making the transition to an ACO? What are the benefits
Last year, the Centers for Medicare & Medicaid Services (CMS) paid $1.5 billion in billing settlements to one third of the nation’s hospitals. Now, CMS has released who got paid what. According to Kaiser Health News (KHN), “the settlements were a compromise to reduce a swollen backlog of disputes over what hospitals argued they were owed¹.”
The shift to value based reimbursement has become inevitable, but Medicaid’s goal of tying 50 percent of all payments to value based initiatives by the end of 2016 may not be met. A recent survey by Health Catalyst shows that hospitals are slow to make the move towards value based initiatives. With only 3% of health systems currently meeting the target and 23% expected to meet the goal only by 2019.
On April 26, 2016 the Department of Health and Human Services (HHS) announced the finalized version of a new rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The “rule advances delivery system reform, strengthens quality and consumer protections, promotes accountability, and aligns Medicaid managed care rules with other health insurance coverage programs.”
The Centers for Medicare & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.
The Centers for Medicare and Medicaid Services (CMS) announced the launch of Comprehensive Primary Care Plus (CPC+), a new initiative that hopes to help transform and improve the ways primary care is delivered and paid for. CPC+ will help primary care practices move away from traditional fee-for-service models and the "one size fits all" mentality, to a more unified system of care where doctors have the freedom to provide the highest quality targeted care for their patients.
The Centers for Medicare and Medicaid Services (CMS) have announced the finalization of a new rule that will help strengthen access to mental health and substance-use services for individuals who receive Medicaid benefits though managed care organizations and those who have Children's Health Insurance Program (CHIP) coverage. According to CMS' press release, this "final rule strengthens access to mental health and substance use disorder benefits for low-income Americans." The new provisions of this rule will benefit the over "23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP."
2016 is going to be a big year for Behavioral Health, thanks to The Excellence in Mental Health Act (ExACT) passed in 2014. the ExACT is a crucial step towards taking Behavioral healthcare off the back burner and sparking an important discussions on mental health. According to the National Council for Behavioral Health the program will “increase Americans’ access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services.” The program has allocated over $1 billion to help protect and enhance community based mental health programs, which is the largest federal investment in behavioral health services in a very long time. Let’s take a look at the progress the Excellence in Mental Health Act has already made and what might be in store for 2016.
Medicaid spending soared nearly 14 percent last year—its biggest annual increase in at least two decades—as a result of millions of newly eligible low-income enrollees signing up under the Affordable Care Act, according to a report released Thursday by the Kaiser Family Foundation. Total spending was highest in the 29 states that expanded Medicaid, the government insurance program for low-income and disabled people, under the health law. In those states, total Medicaid spending jumped nearly 18 percent in the fiscal year that for most states ended June 30, the Kaiser researchers found. (KHN is an editorially independent program of the foundation). In the other states that did not expand, Medicaid spending rose about 6 percent, the report found.