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Tag: Payers

BREAKING: Medicare’s Pioneer Program Down to 19 ACOs After Three More Exit

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Three years after the CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more have decided they no longer want to. The new departures—the program is now down to 19 ACOs—suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models.

Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year.

The ongoing trickle of departures from the Pioneer program underscores the broader tension and debate among providers, policymakers and health systems exploring ways to overhaul the way Medicare pays hospitals and doctors—attempts that have rippled through private markets as commercial health plans follow suit.

Read the full report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Interest Surges in Medicare Bundled-Payment Initiative

Medicare will nearly triple the number of hospitals and medical groups that are candidates to test bundled payments, one of the health reform law’s efforts to revamp healthcare financing.
The CMS announced it will add roughly 4,100 providers to about 2,400 already exploring the possible use of bundled payments for some or all of four dozen medical conditions and procedures, such as diabetes, joint replacements and pacemaker implants. Providers have to apply to become candidates.

These roughly 6,500 candidates will analyze Medicare spending data to decide whether or not to enter into bundled-payment contracts, which must reduce Medicare costs by 2% to 3.5% before providers are rewarded, with some exceptions.

Medicare launched the payment bundles in January 2013 under the healthcare reform law So far, the CMS has signed 243 providers to bundled-payment contracts, which began in October and January.

Read the full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.