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Showing 8 posts in Accountable Care Organizations (“ACO”).

Pharmacists: Aren’t you really providers already? - Part One

Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, HPSA, Medicare, Patient Protection and Affordable Care Act (“ACA”)

While the passage of the Patient Protection and Affordable Care Act (“ACA”) ushered in a new era of access to health care, it only served to exacerbate a growing crisis in the provision of health care – lack of providers. As of April 2015, the Health Resources and Services Administration lists the population of the United States that lives within a health professional shortage area (“HPSA”) for primary care as 103,847,716, with 1,023,989 of those living in Kentucky.[1] This shortage calls for a reimagining of ways that non-physician providers can fill the care gap, and the debate surrounding the provider status of pharmacists with regard to federal health care programs is evidence of a changing mindset. More >

Important Recommendations from the MedPAC March Report to Congress, Part One

Posted In Accountable Care Organizations (“ACO”), Fee for Service, Medicare, Part D

Medicare. Medical Concept.Each March, the Medicare Payment Advisory Commission (“MedPAC” or the “Commission”) is tasked with reporting to Congress on the current state of the Medicare fee-for-service (“FFS”) payment systems, the Medicare Advantage (“MA”) program and the Medicare prescription drug program (“Part D”). This report gives lawmakers recommendations on ways to improve and enhance the Medicare system, as well as shore up areas of concern. This year’s report again struck at the root of systemic problems, specifically noting that an increasing issue within Medicare is a fundamental problem with FFS payment systems – the system incentivizes the delivery of more services without taking into account the value of those additional services. Several reforms in the report are the subject of current Congressional legislation as well. In the posts for both today and Thursday, we’ll parse the various statements and recommendations in MedPAC’s March report with an eye for their effect on the workings of the system. More >

Quality Over Quantity: The Shift from Fee-for-Service to Value-Based Payment Systems

Posted In Accountable Care Organizations (“ACO”), Alternative Payment Models, Fee for Service, Health Care Law, Medicare

The United States Department for Health and Human Services (“HHS”) recently announced its intention to tie thirty percent of fee-for-service Medicare payments to alternative and value-based payment models by 2016. HHS hopes to increase that amount to fifty percent by the end of 2018. Currently, up to twenty percent of payments are made through alternative models, a substantial increase in a short amount of time since almost no payments were made through alternative models as recently as 2011. Two days after HHS’ announcement, a group of key health care industry stakeholders announced the formation of the Health Care Transformation Task Force, a new industry consortium making a public commitment to transition seventy-five percent of its business between now and 2020 to value-based arrangements. These developments demonstrate the shift from fee-for-service payments based on quantity of work regardless of outcome and signals a larger trend to seek quality over quantity. With the seemingly meteoric rise of value-based care, it is important to understand the ramifications of alternative payment models within the health care industry as a whole. More >

The Pioneer Program Report Card

In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”).  The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity. More >

The Kentucky Health Benefit Exchange: How Obamacare is Changing the Health Insurance Marketplace

Now that the President has been re-elected and the Supreme Court has upheld most of the Accountable Care Act (“ACA”), Obamacare will not be repealed. So, what does that mean for Kentuckians?  Several things including an individual mandate to buy health insurance and a health benefit exchange where Kentuckians can buy insurance. More >

Kentucky Health Cooperative Insurance, Available in 2014

The Supreme Court Decision of June 28, 2012 upholding the Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business, et al., v. Sebelius , Secretary of Health and Human Services, et al., reignited the creation and implementation of Consumer Operated and Oriented Plan programs (“CO-OPS”).  CO-OPs are aimed at offering small businesses and individuals more affordable health insurance options, especially in states where there are a few insurance carriers capitalizing the market with plans that are not economically targeted at the smaller insurance market. More >

Accountable Care Organizations Program Models

The Supreme Court’s decision upholding the Affordable Care Act supports The Centers for Medicare and Medicaid Services (CMS) different programs for the development of Accountable Care Organizations (ACOs).  In Kentucky, we are beginning to see these organizations emerge in different models. More >

Supreme Court Decision Legitimizes Accountable Care Organizations

With its decision upholding the Affordable Care Act, the Supreme Court has authorized the use of Accountable Care Organizations (“ACO”) as one of the principal tools for addressing health care costs and improving care.  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely by reducing the rate of growth in the cost of health care, the ACO will share in the savings it achieves for the Medicare program.  The Centers for Medicare and Medicaid Services (“CMS”) announced the selection of 88 ACOs to participate in the first round of the Medicare Shared Savings Program. These ACOs will take responsibility for coordinating care for nearly 1.2 million Medicare beneficiaries in 40 states. Three ACOs have been approved for Kentucky and include Quality Independent Physicians (Louisville), Southern Kentucky Health Care Alliance (Smithsgrove), and Deaconess Care Integration (Serving Indiana and Kentucky). In late July, CMS announced 15 new ACOs to participate in the Advance Payment ACO Model Program including Jackson Purchase Medical Association PSC, which is an ACO that includes 6 physician practices in Paducah and Ballard County Kentucky that covers 6000 Medicare beneficiaries. This brings the total participation in the program to 20.   With the 32 systems approved to participate in the Pioneer ACOs Program in February 2012, CMS announced there are now 153 organizations participating in Medicare Shared Savings initiatives, serving over 2.4 million beneficiaries. More >

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