CMS wants more physicians to participate in ACOs and other alternative payment models (APMs). It’s best if they are risk-taking ACOs, but any ACO seems to be better than none. At least, that is what the incentives in MACRA seem to indicate. Prior to the passage of MACRA (the Medicare Access and CHIP Reauthorization Act […]
John M. Harris and Craig E. Holm describe howimplementation of MACRA bring significant strategic implications for hospitals and health systems as well and physicians.
Physician engagement is critical to CIN success. True engagement, however, takes vigilance and a long-term commitment; having physicians join your network is just the beginning of the process. Our experience has shown that, despite their best intentions, many CINs lose touch with their physician membership at some point along the road. Effectively engaging physicians in […]
Accountable care organizations are at the forefront of the healthcare industry’s transition to value-based care; those that succeed will provide a leading example for the industry to follow.
One hundred and six new ACOs were announced in January, bringing the total to over 250. About 4 million Medicare beneficiaries—8 percent of the total Medicare population—are now getting their care within a Medicare ACO. That means ACOs are overseeing about $40 billion of annual Medicare spending. Four million lives is an impressive number for […]
Many hospitals and health systems have made significant investments in physician practice acquisitions and employment. Often, this has been a defensive strategy, pursued without an expectation of direct profits. Instead, their new employers anticipated that these physicians would “pay for themselves” through downstream inpatient and ancillary service revenues once employed. As healthcare reform has progressed, […]
Today’s provider efforts to form clinically integrated networks (CINs) suggest clinical integration is gaining traction. Providers are starting to address the array of opportunities to improve care, lower cost, and receive the associated rewards. We have seen significant movement in five pillars of clinical integration. Payer Engagement Payers are focusing additional funds on value-based arrangements […]
Many healthcare organizations seem to have short memories when it comes to practice acquisitions and physician employment. In these organizations, board members and even C-suite executives quickly grow impatient with reported losses on new or expanded physician enterprises, forgetting that the original rationale behind the acquisitions was less financial (e.g., contributing direct revenue to the […]
If you’re already participating in or thinking about a new payment model, you’ve probably seen that the pundits insist you must have a full IT infrastructure in place before you push the button on these initiatives. Whether it’s a Medicare accountable care organization (ACO), bundled payment, an ACO-like arrangement for a payer’s Medicare Advantage or […]
Clinically Integrated Networks (CINs) and Accountable Care Organizations (ACOs) are vehicles for evolved forms of capitation that include value-based and risk sharing performance incentives, unlike past reimbursement models which focused primarily on utilization (see Figure below). Both aggregate and align providers, but differ in types of payors. ACOs are paid by Medicare and/or Medicaid, while CINs have commercial insurers. […]