Accountable care organizations are failing to meet their promise to save Medicare money, and regulations governing the model need to change, according to senior White House officials.
Health plans and Medicare are signing new outcome-based contracts with physicians where they share in the savings if they work together to keep patients healthy. Should doctors be on the hook to share in losses if costs increase in spite of their efforts?
Fearing the CMS will force them to take on more financial risk, provider groups are looking to leave the Medicare ACO program.
Some providers believe HHS Secretary Alex Azar will ease provider self-referral restrictions that they say inhibit physicians and hospitals from building accountable care organizations.
CMS Administrator Seema Verma told hospital executives that she will reject Kansas' request to impose lifetime limits on Medicaid coverage. She also came out against allowing ACOs to continue avoiding downside risk.
ACOs say they will shut down if forced to face downside risk, but policy insiders say any delays would affect their stated goal: Medicare savings.
There's no one way to structure an ACO and help it succeed. Beth Israel Deaconess Care Organization's COO offers some tips from the lessons they've learned since launching in 2012.
Emory Healthcare and Walmart are creating an ACO to serve about 10,800 Walmart employees in the Atlanta area. The ACO will include a bundled-payment program for spine surgery and joint replacement.
Risk-averse accountable care organizations are the largest reason why the federal government hasn't yet been able to profit from the program, and they have cost the CMS $384 million in three years, according to a new report.
CMS' risk-adjustment changes under the Next Generation ACO Model sparked concerns from some ACOs that they couldn't make money under the program.
Congress' budget deal included several changes to the Medicare Shared Savings Program that experts say will motivate beneficiaries to be more proactive about their health.
About 91% of the ACOs in non-risk bearing tracks in 2016 would have saved an additional $966 million overall if they were in a contract with downside risk, according to an Avalere Health analysis released Thursday.