Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program) the Next Generation ACO Model offers a new opportunity in accountable careone that sets predictable financial targets enables providers and beneficiaries greater opportunities to coordinate care and aims to attain the highest quality standards of care Specific eligibility criteria are outlined in the Request for Applications (PDF) The Next Generation ACO Models application portal will open in March 2017 and applications will be due in May 2017
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As it rolls out the biggest changes to its Medicaid program in two decades, the state has enlisted six health care provider networks to start testing a new model of delivering and paying for medical care.
The organizations plan to launch pilot programs on Thursday that will cover about 160,000 residents signed up for Medicaid, known here as MassHealth. They include some of the state’s biggest hospitals and hospital systems: Partners HealthCare, Steward Health Care System, University of Massachusetts Memorial Health Care, Boston Medical Center, and Boston Children’s Hospital. A new organization called Community Care Cooperative — a network of community health centers — also is participating.
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The American College of Emergency Physicians is suing HHS, claiming a provision of the Affordable Care Act allows insurers to underpay for out-of-network emergency medical services.
The federal lawsuit asks that insurers be transparent on the data they're using to pay for services rendered by an out-of-network hospital.
The ACA established that in these cases, insurers must pay the greatest of three costs: the insurers' in-network amount, the Medicare amount or the usual, customary and reasonable amount. The UCR, the amount physicians charge for care, is often the greatest of the three.
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133 1 |about 3 years ago
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The CMS has made a handful of final changes to the Affordable Care Act's health insurance marketplaces for 2018, just a little more than a month before Donald Trump takes over the White House and congressional Republicans move to repeal the healthcare reform law.
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The accountable care organization is loosely defined as a collection of doctors hospitals and other providers who agree to take financial responsibility for the quality of care Proponents argue they have great potential to improve healthcare value
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CMS yesterday unveiled a new model for ACOs as part of an attempt to make …
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The first of its kind in the nation, the all-payer accountable care organization (ACO) model allows Vermont the opportunity to create a transformative payment model that moves all payers (Medicare, Medicaid, and commercial) towards a prospective, value-based reimbursement system holding providers, operating through one or more ACOs, and the State of Vermont, accountable for population health outcomes. A joint state and federal initiative designed to transform how health care is paid for and delivered in Vermont, the model agreement is the culmination of nearly two years of discussion and negotiation between the Governor of Vermont, the US Department of Health and Human Services, the Vermont Agency of Human Services, the Centers for Medicare and Medicaid Services (CMS), and the Green Mountain Care Board (Vermont’s quasi-judicial, independent body responsible for health care regulation and reform).
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Heres what the CBO reported on the cost and coverage impact of the House Republicans bill to repeal and replace the Affordable Care Act(All projections are in comparison to current law)Reduce the cumulative federal deficit by 119 billion by 2026 the prior version of the AHCA would have cut the deficit by 150 billionIncrease the number of uninsured by 14 million in 2018 growing to 23 million by 2026 the previous bill would have raised the number of uninsured by 24 million in 2026Result in a total of 51 million uninsured in 2026 compared with 28 million under current lawSignificantly increase the number of uninsured among people ages 50 to 64 with income under 200 of povertyLower federal Medicaid spending by 834 billion over 10 years
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Serving patients eligible for both Medicare and Medicaid will allow ACOs to expand the services they offer, some say.
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While the future of the Affordable Care Act, popularly known as Obamacare, is quite uncertain, parts of the famous healthcare reform act likely will have a lasting impact.
“The transformative opportunity here is all about the reimbursement shift from fee-for-service to the accountable care model, with the Centers for Medicare and Medicaid Services the major driver behind it,” said John Sculley, chairman of the board and chief marketing officer at RxAdvance who previously served as CEO of Apple and PepsiCo. “And as we know there are hundreds of accountable care organizations out there, some operating under one definition and some under others. This is an evolving thing.”
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The health of hundreds of veterans is in question because a dentist at the Tomah Veterans Affairs Medical Center failed to meet proper cleaning standards.
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Republicans who have long called for repealing the Affordable Care Act are pushing for more transition time and delays as they realize the massive consequences of their proposals
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Health Policy Lab Following the ACA Drugs and Medical Innovation Innovations in Care Delivery
[email protected] Health Affairs GrantWatch Health Equity Costs and Spending Global Health Policy Health IT Health Professionals Hospitals Insurance and Coverage Long-term Services and Supports Medicaid and CHIP Medicare Narrative Matters Once in a Weil Organization and Delivery Payment Policy Population Health Public Health Quality Drugs and Medical Technology Timothy Jost December 15, 2016 President-elect Trump has characterized the Affordable Care Act (ACA) as a disaster and has promised to repeal it. They are supported by conservative and libertarian commentators who join in characterizing the ACA as a failure. The report was accompanied by a chart book and blog post summarizing the report.
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In January, Vermont will become the first state in the nation to move to a voluntary all-payer accountable care organization model, the CMS announced Wednesday. The Vermont program is modeled after a similar one from Maryland, but the Maryland program covers only hospitals.
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59 2 |about 2 years ago
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Over the past several years Ive helped dozens of health systems optimize their EHRs to be able to better manage clinical and financial risk in their ACOs In the process Ive observed that many system executives dont fully understand the risk-adjustment concepts that determine value-based payment under MSSP (or other Medicare programs) Often their ACO strategies sufferor completely stallas a result
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First the industry must unhook its terrestrial addiction to fee-for-service models.
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Researchers compared commercial and noncommercial (Medicare or Medicaid) ACOs in a broad range of areas including organizational structure, outcomes, provider compensation, and efficiency.
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Reprint
Mount Pleasant Texas-based Titus Regional Medical Center (TRMC) is the latest victim of a cyberattack of its electronic health record system, with ransomware making it inaccessible, according to an article in The Daily Tribune.
The ransomware virus has encrypted files on several of TRMC's data base services, blocking TRMC's ability to enter or retrieve patient data in EHR. TRMC has implemented a conditional Hospital Incident Command System, and brought in a forensic specialist to deal with the problem.
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25 0 |about 3 years ago
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A compound found in wine and grapes - resveratrol - has been found to help correct hormone imbalance and improve insulin sensitivity in women with PCOS.
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