February 23rd 2024
While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.
February 14th 2024
AMA's McAneny Calls for Real-time Oncology Payment Model Led by Physicians
November 17th 2018In the keynote address at Patient-Centered Oncology Care® 2018, Barbara McAneny, MD, a New Mexico oncologist/hematologist and the current president of the American Medical Association (AMA), shared her diagnosis for the current crisis in US healthcare, as well as a prescription—a new real-time oncology payment model led by physicians.
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Keeping Ahead of the Curve in the Transition to Oncology Value-Based Payment
November 16th 2018At a session of The American Journal of Managed Care®'s Patient-Centered Oncology Care® 2018 meeting, held November 16 in Philadelphia, panelists shared their views on the future of oncology value-based payment models and how they as payers and providers can help advance these models.
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This Week in Managed Care: November 16, 2018
November 16th 2018This week, the top managed care news included research that showed c​​​​ancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available.
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Data and Collaboration Are Key for Value-Based Care Success
November 11th 2018Data and collaboration are necessary ingredients to succeed in the transition to value-based care models, and the money saved under these models will create room to pay for unconventional therapies and services in healthcare, according to panelists at The Institute for Value-Based Medicine meeting in Seattle, Washington.
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Allison Brennan Outlines the Greatest Challenges of the Proposed MSSP Changes
November 11th 2018The shorter timeline to risk and the reduction of shared savings rates are among the 2 greatest challenges accountable care organizations (ACOs) will face as part of the proposed changes to the Medicare Shared Savings Program (MSSP), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.
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Stephen Nuckolls Discusses What May Change Under the Proposed Pathways to Success
November 10th 2018While the proposed changes to the Medicare Shared Savings Program (MSSP) won’t mean a large number of changes to Coastal Carolina Quality Care, the accountable care organization will have to make some changes to respond to the new Enhanced track, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
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Saving Costs While Maintaining Quality of Care—The Value of Biosimilars in Oncology
November 8th 2018According to a review published in Cancer Management and Research, biosimilar products present a viable cost-saving tool for providers participating in value-based care programs such as the Medicare Shared Savings Program or the Oncology Care Model.
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Dr Katherine Schneider: MSSP Proposed Changes Will Be a Step Back on Path to Value
November 7th 2018The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
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Learnings From Priority Health's Oncology Payment Reform Model
November 1st 2018To speak about the success and continued development of Priority Health's payment reform model in cancer care, John Fox, MD, medical director at Priority Health, joined Dennis Zoet, chief business development officer at Cancer and Hematology Centers of Western Michigan, on a panel at the Community Oncology Alliance Payer Exchange Summit.
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Oregon Approves Policies to Continue Value-Based Care Push in Medicaid
October 31st 2018Oregon has approved new policies to continue the transformation of its Medicaid program with a focus on behavioral health, value, and social determinants of health in the state's coordinated care organizations.
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Dr Clif Gaus Discusses Measuring MSSP ACOs Savings
October 31st 2018There are different ways to measure how Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have saved money, and the way used can drastically affect the amount of savings reported, explained Clif Gaus, ScD, president and CEO of the National Association of ACOs.
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Dr Rob Fields: Proposed MSSP Changes Likely to Stifle ACO Movement, Increase Consolidation
October 30th 2018Systems, groups, and practices that haven’t yet joined the accountable care organization (ACO) movement will find it harder to do so if the proposed changes to the Medicare Shared Savings Program (MSSP) take effect, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.
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COA's OCM 2.0: Moving Toward a Universal Payment Model
October 30th 2018The Community Oncology Alliance (COA) has been working with its member practices and some payer partners who have successfully implemented innovative care delivery and payment models to develop a 2.0 version of CMS’ Oncology Care Model (OCM). A progress report was presented at COA’s Payer Exchange Summit held October 29-30 in Tyson’s Corner, Virginia.
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Community Practices Continue to Struggle With ED Use, Risk Stratification in OCM
October 30th 2018While practice transformation is vital, community-based clinics continue to struggle with emergency department (ED) use, hospitalization, and risk stratification as they identify ways to reduce unnecessary expenditures within their Oncology Care Model (OCM) practice.
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Implications of OCM Reports and the Future of the Program
October 29th 2018Lalan Wilfong, MD, moderated a conversation between Robert E. Baird, MD, CEO of Dayton Physicians Network, and Sarah Cevallos, chief revenue cycle officer for Florida Cancer Specialists and Research Institute, about current and future strategies for Oncology Care Model (OCM) participation, as well as key lessons from the OCM and how they can be applied in other reform models.
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Dr Katherine Schneider Highlights How Proposed MSSP Changes Build Stability Into Program
October 27th 2018The proposed changes to the Medicare Shared Savings Program (MSSP) acknowledge the complexity of the program and bring more predictability and stability to MSSP, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
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Dr Barbara McAneny Discusses the Effect of OCM's Second Performance Period Results
October 24th 2018Practices that did not meet cost-savings goals in either the first or second performance periods of the Oncology Care Model (OCM) will likely leave the program, said Barbara L. McAneny, MD, president of the American Medical Association.
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Stephen Nuckolls Outlines His Greatest Challenges and Opportunities of the Proposed MSSP Changes
October 23rd 2018The proposed risk adjustment changes to the Medicare Shared Savings Program (MSSP) are welcome but moving accountable care organizations (ACOs) to risk too soon could harm the program, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
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Payments Are Increasingly Tied to Value, but More Risk-Based Models Needed
October 23rd 2018Approximately one-third of all US healthcare payments in 2017 were tied to alternative payment models, with the remaining still tied to fee for service. The findings of the Health Care Payment Learning and Action Network report highlighted that even as payments move to value-based models, more spending in models with risk is needed.
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ACO Engagement With Urologists Can Reduce Overtreatment of Prostate Cancer
October 21st 2018Accountable care organizations (ACOs) in the Medicare Shared Savings Program vary considerably in how they treat men with newly diagnosed prostate cancer, according to a study that assessed whether the level of engagement in ACOs by urologists could affect rates of treatment, overtreatment, and spending in prostate cancer care.
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Dr Rob Fields Discusses Why More ACOs Might Turn to Medicare Advantage
October 21st 2018The push to get accountable care organizations to take on risk faster could lead to more participation in Medicare Advantage, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.
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Dr Joe Antos: Proposed MSSP Changes Not a Major Shift in Policy for ACOs
October 18th 2018CMS’ proposed changes to the Medicare Shared Savings Program (MSSP) doesn’t represent a major shift in policy stance toward accountable care organizations (ACOs), said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.
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Value-Based Payment Success Hinges on a Holistic Strategy for Changes
October 17th 2018Piecemeal solutions to implement value-based payment arrangements will not be able to effectively enact change. Authors in The New England Journal of Medicine argue that a range of complementary solutions need to be pursued simultaneously based on previously successful tactics on a smaller scale.
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Allison Brennan: Trump's Administration Is Encouraging Risk, but Possibly Too Quickly
October 16th 2018By encouraging more providers to take on risk faster, the current administration may actually be disincentivizing providers from participating at all, which would reduce the number of accountable care organizations (ACOs), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.
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ACOs Had No Significant Impact on Spending for Patients With Cancer
October 14th 2018Accountable care organizations (ACOs) have not had a significant impact on cancer care costs and utilization. While cancer care costs did decline from before the introduction of ACOs to after, there was no significant difference in spending decreases between ACO practices and non-ACO practices caring for patients with cancer.
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Stephen Nuckolls: 2 Years Isn't Enough Time for an ACO to Take on Risk
October 14th 2018The proposed changes to the Medicare Shared Savings Program that move accountable care organizations (ACOs) to take on risk in just 2 years is not going to be enough time for most ACOs, although some may be ready in that time, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
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The US Oncology Network Announces Highly Positive MIPS Results for 2017
October 12th 2018Practices in the US Oncology Network received an average positive payment adjustment under the Merit-based Incentive Payment System (MIPS) of 1.90% for performance in 2017, and 99% of the Network’s physicians were in the top tier of performers. The maximum allowable adjustment is 2.02%. The adjustment based on a clinician’s performance in 2017 impacts the clinician's Medicare reimbursement for 2019.
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