Part 2 of Our Breakdown of the CMS Primary Cares Initiatives: Direct Contracting

The Centers for Medicare & Medicaid Services (CMS) Primary Cares Initiative announced in April 2019 was two-part. We have already covered the Primary Care First (PCF) payment model options; now, we are moving into another group of value-based models that organizations can choose from called Direct Contracting (DC). These voluntary payment structures allow providers to take on risk while operating under value-based care principles to cut costs and increase the quality of care. Plus, Direct Contracting offers enhanced flexibility for providers to help their patients beyond their immediate medical needs. Direct Contracting Objectives As Primary Care First’s foundation was the …

Part 1 of Our Breakdown of the CMS Primary Cares Initiatives: Primary Care First

Announced in April of 2019, the Centers for Medicare & Medicaid Services (CMS) revealed two new paths of payment options for primary care and other providers pursuing risk-based agreements: Primary Care First (PCF) and Direct Contracting (DC). As with any new CMS guideline, there is much to unpack. This week, we are discussing Primary Care First and the options primary care providers (PCPs) have based on their patients. Primary Care First “Primary Care First reflects a regionally-based, multi-payer approach to care delivery and payment. Primary Care First fosters practitioner independence by increasing flexibility for primary care, providing participating practitioners with …

OIG Series Strategy 1: Working with Physicians

We recently kicked off a blog series discussing the seven key strategies that 20 high performing ACOs utilized to elevate quality scores and achieve shared savings. These success stories were chronicled in the latest study from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (DHHS). As a physician with over 30 years of experience and a first-hand witness to ground-up clinical transformations, I can say with certainty that involving physicians from start to finish is fundamental. Having physicians on board while working towards sustained high quality scores and cost-effective utilization practices is the …

The Journey to Value-Based Care: No Longer in Death Valley, But Still Stuck in the Wilderness

Transitioning traditional healthcare to value-based care models hasn’t been easy. People are reluctant to embrace change, especially when it comes to something as important as caring for our patients’ health. Think of this value-based care transition like a cross-country journey from Los Angeles to New York City. It’s a long haul that begins with battling everyone else on clogged freeways to discover a clear path out of the congestion and on the road to our ultimate destination. Where are we now? Some may say we’re stuck in Death Valley…not even out of California, with many providers still struggling to comply …

MACRA – What You Don’t Know Can Hurt You

Earlier this year, the Deloitte Center for Health Solutions 2016 Survey of US Physicians queried a subsample of 523 physicians (non-pediatric specialties) about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The initial findings presented some interesting surprises to various stakeholders across the entire healthcare industry. In a nutshell, MACRA is the new Medicare payment law driving the healthcare industry toward the path of value-based care and away from fee-for-service models. By aligning payment with quality and outcomes, MACRA offers financial incentives to healthcare providers who take part in risk-bearing, coordinated care models. The initial law was passed …