CMMI Refines and Extends Enhancing Oncology Model

Healthcare Innovation | May 31, 2024

On May 30, the Centers for Medicare & Medicaid Services announced the opening of a second round of applications to join the Enhancing Oncology Model (EOM) in July 2025. The application portal to apply will open in July 2024. EOM is a voluntary payment model intended to transform care for cancer patients. EOM aims to improve care coordination, quality, and health outcomes for patients while also holding oncology practices accountable for total costs of care to make cancer care more affordable, equitable, and accessible for patients and Medicare. There are 41 practices and three payers participating in the first cohort. The Center for Medicare & Medicaid Innovation (CMMI) also announced several refinements to the model’s policies, including...

ACOs Need A Strategic Map For Cost Control

Roji Health Intelligence | June 5, 2024

For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO PC Flex model, which is designed to create per-patient reimbursement for small ACOs in trade for higher reimbursements and funding for infrastructure. Most newer CMS payment models are now incorporating per-patient payments designed to lower the total cost of care. As the provider-driven vanguard in the Medicare Value-Based Care effort, ACOs’ total savings represent just slightly over 1 percent of $944.3 billion in total Medicare spending.

Who is leaning into value-based care?

Becker's ASC Review | June 6, 2024

As value-based care becomes commonplace throughout the U.S. healthcare system, physicians and practices are learning how to lean into the trend. Here are seven practices and physicians leaning into value-based care in 2024: (1.) Sterling Elliott, PharmD, assistant professor for orthopedic surgery and clinical pharmacist lead at Northwestern Medicine in Chicago, told Becker’s that he is focused on value-based care this year. “I’m looking at ways to optimize value with the prospect that value-based care is the emerging direction in the American healthcare landscape,” Dr. Elliott told Becker’s. “Revenues are critical to the financial wellbeing of the business model, and when change steamrolls through, adaptation will reign supreme. Change is scary and uncomfortable, but finding ways to capitalize can have widespread benefit. In the end, finding innovative approaches to patient care services sets us up to provide high quality patient care and safeguard the stability of our economic landscape.”

Value-based care is the future of health care, but we need leadership to get there

Medical Economics | June 6, 2024

The annual government “strategy” to contain the cost of health care by cutting rates misses the cause of the problem: the fee-for-service (FFS) reimbursement model and its disconnect from outcomes that matter. By paying providers based on the number of services they deliver to each patient – tests, examinations, images, etc. – FFS incentivizes providers to deliver more services. It effectively guarantees increasing costs unrelated to outcomes. This broken model, in combination with CMS’ efforts to contain costs, promises to cripple our health care delivery system unless providers transition to a value-based care model – and soon. Between 2001 and 2023, inflation-adjusted Medicare physician payments declined 26%, even as the cost of providing services nearly doubled. Physicians are opting out of Medicare with increasing frequency because of the financial loss associated with treating Medicare patients.