Alternative Payment Models

Latest News

Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

Beyond Navigation: Thyme Care Ready for Heavy Lifts to Make Value-Based Care Work

By Mary Caffrey

October 12th 2024

Setting the Course for Comprehensive Care Navigation in Oncology

By Vishnukamal Golla, MD, MPH
Allan Zuckoff, PhD

October 11th 2024

Patient Assignment and Quality Performance: A Misaligned System

By Kailey Love, MBA, MS
Stefanie Turner, MHI

October 9th 2024

Clinical Trials Won’t Cause Financial Harm for Practices in Medicare Payment Models, Study Finds

By Interview by Mary Caffrey

June 28th 2024

More News

January 24th 2018

Dr Peter Aran on What Oncologists Implementing OCM Can Learn From Existing Models

Over the next years, these spheres (ACOs, primary care, and oncology) that are going on in CMMI need to be coalesced together so that when we have learning collaboratives, not only do we have learning collaboratives within each of these spheres, but we learn from each other in these similar projects, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

January 24th 2018

561 ACOs Participating in Medicare Shared Savings Program in 2018

Jaime Rosenberg

Earlier this month, CMS announced that 561 accountable care organizations will be participating in the Medicare Shared Savings Program in 2018, with 10.5 million assigned beneficiaries.

January 22nd 2018

The Fallacy of Estimating OCM Target Prices

Darcie Hurteau

Estimating episodic target prices for each patient in the Oncology Care Model (OCM) can be challenging and time consuming. Applying that time to quality-focused care management tactics, based on observed utilization and patient outcomes, may wind up being more valuable, and help to reduce unnecessary spending.

January 20th 2018

Dr Roger Brito Discusses Implementing Alternative Payment Models and Its Challenges

Aetna is focusing on the healthcare triangle (patients, providers, and payers) and connecting those lines, said Roger Brito, DO, national director for oncology, Aetna.

January 19th 2018

Terrill Jordan Discusses the Process of Customizing an EMR to Adapt to OCM

In order to adapt to the Oncology Care Model (OCM), Regional Cancer Care Associates had to undergo the process of adjusting and customizing its electronic medical records, explained CEO Terrill Jordan.

January 18th 2018

MACRA Continues to Catalyze Movement Towards Value

The Health Management Academy

Given that 2018 marks the last year of the transition-year policies, implementation challenges identified during the first 2 years of Medicare Access and CHIP Reauthorization Act (MACRA) preparation and execution must be addressed to ensure effective delivery of high-value care as intended.

January 15th 2018

David Merrill and John Robinson Discuss Barriers to APMs, Factors of Interest

The ability to have a plan that’s going to work and be large enough that it makes sense for those involved is a barrier for employers who want to pursue alternative payment models, said David Merrill, HR benefits manager, Volusia County, Florida, and John Robinson, CEBS, REBC, RHU, president and CEO, RobinsonBush.

January 12th 2018

MedPAC Votes a Resounding "No" to MIPS, Recommends Voluntary Value Program

Surabhi Dangi-Garimella, PhD

The Medicare Payment Advisory Commission (MedPAC) conducted a formal vote that recommend repealing and replacing CMS’ Merit-based Incentive Payment System (MIPS).

January 12th 2018

Dr Jeff Patton Discusses Preparing for OCM, Seeing Improved Outcomes and Savings

It’s very unusual to see significant cost savings in the first year of a program; that was true of all the pioneer ACO programs, said Jeff Patton, MD, CEO of Tennessee Oncology.

January 11th 2018

Maine Insurer Sues HHS Over CSR Payments

Jaime Rosenberg

Maine Community Health Options is seeking $5.6 million from HHS, claiming the department failed to reimburse marketplace insurers for cost-sharing reductions for 2017. Under section 1402 of the Affordable Care Act, an insurer participating in the marketplace is required to offer CSR plans, and in return will be guaranteed reimbursement by the government.

January 10th 2018

Sarah Cevallos on Her Advice for Practices Looking to Participate in OCM

Don’t underestimate the power that it takes to make sure a value-based program is working, said Sarah Cevallos, chief revenue cycle officer, Florida Cancer Specialists.

January 9th 2018

Dr Roger Brito: What Patients Should Know About Alternative Payment Models, OCM

The healthcare triangle (patients, payers, and providers) begins with the patient, so we should include the patient in some of the decision-making, said Roger Brito, DO, national director for oncology, Aetna.

December 29th 2017

Top 2017 Articles in AJMC®'s Evidence-Based OncologyTM

Surabhi Dangi-Garimella, PhD

A look at the most popular articles published in Evidence-Based Oncology™ in 2017.

December 28th 2017

Modernizing the Stark Law Will Improve Care for Medicare Patients and Lower Costs

Digestive Health Physicians Association

Curbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.

December 26th 2017

What We're Reading: Hospital Penalization; New APMs; EHR Challenges

AJMC Staff

More than 700 hospitals were penalized for having the highest rates of patient injuries; the Physician-focused Payment Technical Advisory Committee backed 2 new alternative payment models; and experts outline the biggest challenges of implementing and maintaining electronic health records going into the new year.

December 11th 2017

CJR Voluntary Participation—Should I Stay or Should I Go?

Darcie Hurteau

This article focuses on the financial results that may accrue to a participating hospital throughout the remainder of the Comprehensive Care for Joint Replacement program as a result of the migration from historical baseline to regional target rates, and rebasing of the historical baseline.

December 8th 2017

Dr Lucio Gordan: Improving Population Health Through Alternative Payment Models

As people get more empowered and more informed with data, such as their own electronic medical records, they will utilize the information to do better for themselves and improve their health, said Lucio Gordan, MD, of Florida Cancer Specialists.

December 7th 2017

Dr Ira Klein on Pharmaceutical Interest in Alternative Payment Models

Pharmaceutical companies would like to see value-based contracts that are multi-year and over large populations, said Ira Klein, MD, MBA, FACP, senior director of healthcare quality strategy for the Strategic Customer Group at Janssen Pharmaceuticals.

December 5th 2017

Transitioning Community Hospitals to Value-Based Care: Lessons From Massachusetts

Christopher J. Louis, PhD, MHA, Sara S. Bachman, PhD, MS Dylan H. Roby, PhD Lauren Melby, MBA, MPP David L. Rosenbloom, PhD

This article examines the evolution of the Community Hospital Acceleration, Revitalization and Transformation investment program in Massachusetts and informs other states seeking to transform care delivery in community hospitals toward value-based care.

December 1st 2017

CMS Finalizes Changes to Joint Replacement Bundles; Verma Promises Shift to Voluntary Models

Mary Caffrey

Scaling back the Comprehensive Care for Joint Replacement model and canceling an expansion proposed under the Obama administration represents a shift in philosophy from mandatory to voluntary bundled payment models. But some say that commercial payers and employers will demand change no matter what CMS does.

October 24th 2017

How Has the OCM Evolved? Year 1 Provider Updates

Surabhi Dangi-Garimella, PhD

Participants from 2 oncology community practices—an oncologist–administrator combination—shared their experience with implementing the Oncology Care Model (OCM) with attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

September 20th 2017

Federally Qualified Health Centers Prepare for Challenging Path Ahead

Christina Mattina

Federally qualified health centers face significant financial and competitive pressures, but executives reported in a recent survey that they have identified areas for improvement and are planning a path to success.

September 12th 2017

MACRA Survey Finds Oncology Physicians Unprepared for Payment Changes

Surabhi Dangi-Garimella, PhD

A recent survey conducted by Integra Connect has found that a majority of specialty physicians have not yet invested in operational changes that may be essential for their success under value-based care reimbursement models.

July 21st 2017

CMS Seeks Ideas for Innovative Behavioral Health Payment Model

Christina Mattina

CMS announced it will hold a meeting to gather input on potential models to pay for behavioral healthcare that would improve quality, expand access, and lower costs for beneficiaries.

July 1st 2017

Dr Zirui Song Discusses Early Effects of Payment Reform on Physician Behavior

Public and private payment reforms such as accountable care organization contracts have shown some initial evidence of changes in physician behavior, but their full promise remains to be seen, according to Zirui Song, MD, PhD, resident at Massachusetts General Hospital.

June 22nd 2017

Developing a Creative Strategy to Present the Value of Oncology Drugs

Surabhi Dangi-Garimella, PhD

At the 8th Annual Oncology Market Access & Pricing USA 2017 meeting hosted by eyeforpharma, Sriram Shankar, senior consultant, INC Strategy Consulting, shared his thoughts on the implications of value frameworks for payer strategy.

June 13th 2017

AMA Chooses Oncologist Dr Barbara McAneny to Lead as President-Elect

Christina Mattina

The American Medical Association (AMA) has announced its choice of Barbara McAneny, MD, to lead as president-elect, making her the first oncologist to take the reins of the nation’s largest physician organization.

May 14th 2017

Allison Silvers on Payment Model Flexibility in Palliative Care

Fee-for-service payment models have not been successful in the field of palliative care, where small practices seem to work better under flexible programs like per member per month, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

April 19th 2017

Making Sense of Advanced Payment Models

Barbara McAneny, MD Stephen S. Grubbs, MD Walter Birch, MBA Dan Sayam Zuckerman, MD

The American Society of Clinical Oncology has developed the Patient-Centered Oncology Payment (PCOP) model with the hope that PCOP will be accepted by CMS as an advanced alternative payment model, and become available to medical oncologists as an alternative to the Merit-based Incentive Payment System.

April 19th 2017

Why Oncologists Need Technology to Succeed in Alternative Payment Models

Brenton Fargnoli, MD Ryan Holleran

The emergence of alternative payment models, as exemplified by the Oncology Care Model, is requiring oncologists to develop new solutions to meet the requirements of these programs. Technology available at the point of care offers an efficient solution to many of the most labor-intensive processes.

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