Medicare Advantage patients account for fewer avoidable hospitalizations. Here's why
Fierce Healthcare
FEBRUARY 27, 2023
Medicare Advantage patients account for fewer avoidable hospitalizations. Here's why rking Mon, 02/27/2023 - 17:41
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Fierce Healthcare
FEBRUARY 27, 2023
Medicare Advantage patients account for fewer avoidable hospitalizations. Here's why rking Mon, 02/27/2023 - 17:41
Fierce Healthcare
FEBRUARY 17, 2023
Optum study: Accountable Medicare Advantage models produce better outcomes, greater efficiency pminemyer Fri, 02/17/2023 - 13:40
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Fierce Healthcare
JULY 13, 2023
Approximately 22% of gross Medicare Part D spending can be attributed to 10 top-selling prescription drugs, according to analysis from KFF. | A new analysis shows a small number of prescription drugs disproportionately make up Medicare Part D spending.
Health Care Dive
MAY 20, 2024
On Friday, the committee released a white paper proposing Medicare adjust doctor reimbursement to account for inflation, a key goal for physician lobbies.
Health Care Dive
DECEMBER 20, 2022
The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.
Health Care Dive
APRIL 17, 2024
Independent practices have clearer financial incentives to lower medical spending than hospitals participating in accountable care organizations, according to the Congressional Budget Office.
HIT Consultant
APRIL 16, 2024
What You Should Know: – inVio Health Network and CVS Accountable Care Organization, a division of CVS Health , have announced a collaboration to participate in the new Medicare Accountable Care Organization (ACO) REACH program. CVS Accountable Care contributes its extensive experience and resources.
Home Health Care
JUNE 26, 2024
Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. Overall, CMS estimates that Medicare payments to home health agencies in CY 2025 would decrease in the aggregate by 1.7%, or by about $280 million, compared to 2024 levels. This is a developing story.
Health Care Dive
OCTOBER 21, 2021
Officials acknowledged provider concerns that current models are too burdensome and benchmarks too complex, which the innovation center aims to rectify.
Health Business Group
JULY 18, 2024
In this episode, we dive deep into this pressing question with Dr. Mohamed Diab , president of CVS Accountable Care. Can value-based care transform the American healthcare system? Dr. Diab highlights systemic challenges, such as physician burnout and the inadequacies of primary care funding.
Healthcare ECONOMIST
MAY 5, 2024
To account for differences in disease burden across a Medicare Advantage (MA) plans patient population, uses risk adjustment based on patient disease burden. One key question is whether providers under traditional Medicare (TM) code differently than Medicare Advantage (MA) plans. diabetes, heart failure).
Fierce Healthcare
APRIL 11, 2024
Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid Services (CMS) said Thursday that the | Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid (..)
Healthcare It News
MARCH 30, 2022
Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.
Home Health Care
JUNE 24, 2024
NYSE: EHAB) defended its strategy of taking on more Medicare Advantage (MA) revenue over the last couple of years. Enhabit now has about 61% of its home health revenue tied to fee-for-service Medicare. At that time, traditional Medicare made up approximately 75% of Enhabit’s total Home Health revenue. “At of Enhabit shares.
Fierce Healthcare
AUGUST 2, 2024
The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. Accountable care organizations are evaluating the impacts of the new requirements for the ACO REACH program. So far, the changes are a mixed bag, says NAACOS.
Fierce Healthcare
JANUARY 29, 2024
In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program and 71 ACOs renewed participation, according to new numbers released by Centers for Medicare & Medicaid | CMS released new data Monday showing ACO participation in the Medicare Shared Savings Program, with 19 ACOs set to participate in a new payment option, (..)
Home Health Care
MAY 29, 2024
Medicare Advantage (MA) – the offshoot of traditional Medicare that’s administered by private insurance companies – has recently caught a lot of flak. Centers for Medicare & Medicaid Services (CMS) has been collecting feedback on the MA program through a request for information (RFI) process.
Healthcare ECONOMIST
JULY 21, 2023
The Kaiser Family Foundation (KFF) identifies the Part D drugs on which Medicare spends the most money. In 2021, Medicare Part D covered more than 3,500 prescription drug products, with total gross spending of $216 billion, not accounting for rebates paid by drug manufacturers to pharmacy benefit managers (PBMs).
HIT Consultant
JANUARY 25, 2024
What You Should Know: The Ohio State University Wexner Medical Center a nd CVS Accountable Care, part of CVS Health® (NYSE: CVS), today announced the creation of an accountable care organization (ACO) to improve the quality of care for Medicare beneficiaries by Ohio State providers in central Ohio.
Briggs Healthcare
JANUARY 31, 2023
Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized the policies for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program, which is CMS’s primary audit and oversight tool of MA program payments.
Home Health Care
MAY 15, 2022
Accountable care organizations (ACOs) have considerably increased their home-based care arsenals over recent years. That’s according to the Institute for Accountable Care (IAC), which conducted a wide-ranging study on ACOs and home-based care that was released Thursday. Source: Institute for Accountable Care.
Home Health Care
MAY 16, 2024
This article is a part of your HHCN+ Membership If there were ever a time for Medicare Advantage-related troubles to cool off in the home health care space, now would be it. For the first time ever, in 2023, there were more Medicare beneficiaries under an MA plan than traditional Medicare.
Health Care Dive
AUGUST 25, 2023
Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.
p3care
NOVEMBER 25, 2020
In the last quarter of 2020, CMS (Centers for Medicare & Medicaid Services) announced the performance scores for clinicians of QPP MIPS 2019 on its official site. It accounts for quality healthcare services, that CMS recognizes and rewards for. Check Points for Performance Review.
Healthcare It News
MARCH 4, 2022
Medicare spends nearly $60 billion on post-acute care annually. Why do you suggest that care coordination with post-acute providers will become more critical than before to support the rise of value-based care? What needs to happen? Post-acute care is a key part of the care continuum and a significant component of healthcare spend.
Fierce Healthcare
DECEMBER 13, 2023
A jump in claim delays and denials is “wreaking havoc on providers’ revenue cycle performance” and contributing to health systems’ “volatile” accounts receivable and diminishing cash reserves, acco | More frequent pushback from commercial and Medicare Advantage payers is complicating patient self-pay collections and, ultimately, undermining the revenues (..)
Fierce Healthcare
JUNE 8, 2023
Phase 1 enrollment in the Medicare Shared Savings Program (MSSP) for 2024 is currently underway, and recent reforms hold promise in attracting new providers into accountable care.
Healthcare ECONOMIST
NOVEMBER 29, 2023
Just this year a majority of Medicare beneficiaries enrolled in a Medicare Advantage plan. While these plans are popular with patients, I recently wrote that some rural providers are refusing to accept Medicare Advantage due to low reimbursement.
Home Health Care
AUGUST 25, 2023
The Medicare Shared Savings Program (MSSP) continues to save Medicare over a billion dollars annually. And some of the highest-performing, most innovative Accountable Care Organizations (ACOs) participating in the program continue to generate savings by effectively using home-based care.
Fierce Healthcare
JULY 1, 2024
Accountable care organizations concerned they would be held responsible for bad actors exploiting the Medicare system can breathe a sigh of relief. ACOs may soon be able to take a breath of fresh air, as CMS shared Friday that it has no intention of punishing them for a urinary catheter fraud scandal.
Health Care Dive
JANUARY 24, 2023
Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH.
Fierce Healthcare
NOVEMBER 29, 2023
Accountable care organizations do not positively influence treatment and outcomes for chronic mental health conditions for Medicare patients, according to a study in Health Affairs. | A new study pours water on the belief that ACOs are well-suited to handle chronic mental health conditions its patients experience.
Home Health Care
NOVEMBER 7, 2023
Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030. million Medicare fee-for-service beneficiaries are assigned to an ACO. Currently, roughly 13.2 We’d like to try it that way.’
Fierce Healthcare
APRIL 16, 2024
CVS Accountable Care and inVio Health Network, a collection of more than 600 providers in South Carolina, are partnering to improve care outcomes for 60,000 Medicare beneficiaries. |
Health Populi
JUNE 17, 2024
You would assume that most people over 50 would be worried about the financial future of Medicare to cover health care as those middle-aged Americans age. See that the stats on pessimism running high for the prospects of wellbeing — financial, quality of life, and physical health — are greater when accounting for people under 65.
Fierce Healthcare
MARCH 19, 2024
The Centers for Medicare & Medicaid Services (CMS) has announced the ACO Primary Care Flex Model (ACO PC Flex Model), allowing eligible accountable care organizations to treat people with with | Accountable care organizations are largely supportive of CMS' new primary care model released Tuesday, they wish the agency would broaden its scope (..)
Health Care Dive
DECEMBER 6, 2023
The beleaguered insurer will leave the accountable care program at the end of the 2023 performance year following disappointing results in Medicare direct contracting.
NASHP
SEPTEMBER 5, 2023
On August 29, the Centers for Medicare & Medicaid Services (CMS) announced the first 10 prescription drugs that will be subject to negotiation for Medicare under the Inflation Reduction Act (IRA). CMS will publish the MFPs on September 1, 2024, and they will be effective on January 1, 2026 for all purchases under Medicare Part D.
Health Care Dive
DECEMBER 9, 2022
Accountable care organizations' net savings rates ranged from -29.4% in the 2021 Global and Professional Direct Contracting Model.
Home Health Care
AUGUST 1, 2022
Federal watchdogs reported the Centers for Medicare & Medicaid Services (CMS) has not collected the near-$500 million in Medicare overpayments that were found in audits over a two-year period beginning in 2014. The post CMS, OIG Disconnect Highlighted In Medicare Overpayments Report appeared first on Home Health Care News.
Health Care Dive
JULY 8, 2022
Changes to the Medicare Shared Savings Program would give some accountable care organizations more time to ramp up to performance-based risk and updated quality reporting.
Sheppard Health Law
FEBRUARY 1, 2023
On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. 3d 1, 18 n.19
NASHP
AUGUST 21, 2023
The National Academy for State Health Policy (NASHP) is pleased to announce a new initiative to work with states to strengthen oversight and accountability of managed long-term services and supports (MLTSS) plans, with a particular focus on payment strategies. To get updates about this opportunity, sign up for NASHP’s weekly newsletter.
Home Health Care
AUGUST 30, 2021
CommonSpirit Health carved out $136 million in savings to Medicare for 2020, while also improving overall outcomes for hundreds of thousands of beneficiaries, the company recently announced. CommonSpirit Health is a participant in the Medicare Shared Savings Program (MSSP), which began back in 2012 after being designed by the U.S.
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