The 2025 CMS PFS Rule landed with a bang, and it’s not just the weight of the 3,088 pages. We’re one year closer to 2030, the year that CMS intends to have all Traditional Medicare patients in a relationship with a clinician who is accountable for total cost of care. The push to the […]
Your ACO May Already Be Late for APP Reporting. Here’s How to Catch Up!
With one year remaining before mandatory APP Reporting in 2026, the idea that you’re already late may sound exaggerated. But consider the significance of what you’re undertaking: This is your first effort to report quality on all your beneficiaries, not just a tiny sliver of patients. It’s a huge leap that requires a lot […]
To Unlock ACO Access to Real Savings, Start with Trusted Data
Value-Based Care payment models are based on a clear CMS goal: lower Total Cost of Care and its counterpart, Total Per Capita Cost. But neither TCoC nor TPCC gives you the information you need to target your cost efforts. How to start? Begin by evaluating what initiatives you need to do in the five […]
5 Ways Your ACO Should Leverage Data for Cost Control
In creating your strategies for cost control, your ACO must consider how to reduce Total Per Capita Cost (TPCC) while ensuring the financial survival of your ACO and participating providers. This balancing act is the dilemma facing all providers adopting Value-Based Care: how to achieve more savings while replacing revenue lost from services. Here’s […]
CMS Presses for Accountable Care, Better Quality Measurement for Physicians and ACOs in New Proposed Rule
July brings us baseball, fireworks, and CMS’s Proposed Rules. In 2,248 pages of proposals, CMS has outlined its plans for MIPS, ACOs, and other Advanced Alternate Payment Models, and how they will transition from fee-for-service into a value-based care arrangement through the Quality Payment Program (QPP). We already know from the 2024 Final Rule […]
Strategies for Right Now to Control Patient Care Costs
Policymaker confidence in Value-Based Care and the Accountable Care Organization (ACO) model has, so far, prevailed despite only small overall savings. There is still enduring belief that ACOs can rationalize health care and produce affordability by transformative strategies. But here’s where wishes and reality conflict: ACOs have, until now, lacked the data and […]
ACOs Need a Strategic Map for Cost Control
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 […]
2022 QPP Experience Report: Address 3 Key Findings Now to Avoid Future Penalties
At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) […]
3 Ways Your ACO Can Convert APP Reporting Data into Higher Savings
Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That […]
These Five Trends Are Steering Your Future Path to Value-Based Care
Buckle your seat belt. Health care is changing at warp speed. The Value-Based Care movement and leaps in technology and Artificial Intelligence are rapidly generating advances that will transform the health care environment. These factors will redefine health care providers and services, and how consumers access them. How you respond strategically will determine […]