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May 4, 2017

ACO roundup: Anthem nears 60 percent in value-based spending

Daily Briefing
  • CMS notifying clinicians of MIPS participation status. CMS announced that it will mail notices to health care practices in late April through May, alerting them as to which providers must participate in the Merit-based Incentive Payment System (MIPS), one of two new clinician payment models established under MACRA. According to CMS, physicians, PAs, NPs, clinical nurse specialists, certified registered nurses, and anesthetists should participate in MIPS this year if they annually treat more than 100 patients enrolled in Medicare Part B and bill more than $30,000 in Part B allowed charges.

  • Nearly 60 percent of Anthem business is in alternative payment models. Anthem CEO Joseph Swedish last week announced that 58 percent of the insurer's medical spend is linked to value-based care models. Of those, 75 percent are shared savings, shared risk, and population-based payment models, Swedish said. According to Swedish, Anthem has "over 64,000 providers now engaged in ACOs and patient-centered medical homes who are accountable for cost and quality of care for over 5.5 million commercial members, which is a huge uptick compared to prior years."

  • ACA's coverage expansions didn't disrupt care access for previously insured. The Affordable Care Act's (ACA) health insurance expansions did not affect access to care for U.S. residents who already had insurance before the expansions took effect, according to a study published Monday in Health Affairs. In addition, the researchers found that the ACA's coverage expansions had a positive effect on individuals having a usual source of care, as well as on the time it took for individuals to schedule doctor appointments.

From Advisory Board:

  • What the best patient access initiatives do differently. Even though health care reform is in a state of uncertainty, one thing is for sure: helping consumers access care in your ambulatory network is a priority no matter the political outcomes. Join us May 22 to learn what makes the most successful patient access initiatives stand apart from the crowd.

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  • How to pick the right Medicare ACO program. With the government’s continued focus on alternative payment models and the implementation of MACRA underway, providers must confront major Medicare contracting decisions. Join us on May 12 to learn how to evaluate risk for your fee-for-service Medicare population with the Health Care Advisory Board’s latest analysis of the Medicare ACO programs.

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