Value-based care

Participation in the main Medicare Shared Savings Program is decreasing but 132 accountable care organizations with 2.1 million assigned beneficiaries are participating in the ACO REACH model this year.

CMS announced today that 456 accountable care organizations (ACOs) will participate in Medicare Shared Savings Plan program in 2023, a decrease from the 483 ACOs that participated last year. But 132 ACOs have signed up to participate in the ACO REACH, an increase from 99 last year.

The $8.9 billion deal comes on the heels of multibillion dollar healthcare acquisitions this year by Amazon and CVS Health. Will the spree continue?

Overall survival is considered a more definitive end point. But according to Vinay Prasad, M.D., M.P.H., and colleagues , drugs approved based on progression-free survival and overall response rate were priced higher than those approved based on overall survival.

The program reduced per-episode spending as intended, the researchers found. But those savings were offset by bonuses paid to hospitals for beating financial benchmarks, leading to a net loss.

Risk adjustment is a central feature of value-based care, but it can be abused. Natural language processing can make the process efficient and steer it clear of fraud and other problems.

The Centers for Medicare and Medicaid Services released results today showing that on a per capita basis, the net savings for low-revenue accountable care organizations (ACOs) was higher than the net savings for high-revenue ACOs.

CVS Health and United Health Group are also reportedly among the bidders.

The trend of primary care practices and businesses bearing risk has pitfalls. A trio of experts have suggestions for how they can be avoided, including taking steps to de-emphasizing diagnostic coding in the calculations that determine payment.

Medicaid managed care organization (MCOs) may be better equipped to address social determinants of health (SDOH) and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination.