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Accountable Care Organizations (ACO)

When doctors, hospitals, and other providers come together to form an Accountable Care Organization, high quality, affordably managed care for Medicare patients is the intended outcome. Can the best intentions yield the best outcomes?

Fee-for-Service Continues to Account for the Majority of Revenue

New Marketplace

New Marketplace Survey: Transitioning Payment Models: Fee-for-Service to Value-Based Care

In a survey of the NEJM Catalyst Insights Council sponsored by Optum, respondents express enthusiasm for value-based care but have conflicting opinions about just how far along that path they should go.

Murray02_pullquote surgical care bundled payments accountable care organizations

New Marketplace

Surgical Value — Beyond Bundled Payments

The surgeon has a crucial role in defining value for patients in a population — and not just when that patient is in need of the surgeon’s knife.

Comparison Between Traditional and Proposed Health Reimbursement Plan for Primary Care Outcomes Model Across Five Key Domains

New Marketplace

Payment Designed for People: Introducing the Primary Care Outcomes Model

A care and payment model that engages primary care physicians in an aligned model built on trust and value could result in better patient care at lower costs.

Figure 1. Differential Changes in Total Medicare Spending for Patients in Accountable Care Organizations (ACOs), According to the Type of ACO, Year of Entry, and Number of Years of Participation.

New Marketplace

Medicare Spending after 3 Years of the Medicare Shared Savings Program

After 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period.

Alaigh03_pullquote aco and bundled payment co-exist

New Marketplace

ACOs and Bundled Payments: How the Two Can and Should Coexist

The integration of primary care and specialty care physicians through adoption of both payment models will lead to synergistic value.

Shachar01_pullquote value-based care fee-for-service fraud and abuse laws

New Marketplace

Are Fraud and Abuse Laws Stifling Value-Based Care?

To realize the true potential of value-based care, we must update the underlying assumptions in our fraud and abuse regulatory system.

Hospital-based ACOs Key Capabilities Are Different Based on Level of Risk

New Marketplace

Hospital-based ACOs Face Challenges in Tracking Performance Indicators

A focus on bundled payments for specific episodes of care — versus the broad changes required in an ACO model — may be a more effective method for ACO participants to develop capabilities required to measure utilization, cost, and revenue metrics.

Griffin Myers Head Shot Oak Street Health

Care Redesign

Rebuilding Health Care as It Should Be: Personal, Equitable, and Accountable

How Oak Street Health, a full-risk, value-based primary care model and social determinants practice, embeds itself in the community to keep its elderly population, “happy, healthy, and out of the hospital.”

Growth in alternative payment models shared savings shared risk bundled payments population-based payments

New Marketplace

The State of the Evidence on Payment Reform

Despite some successes among the many efforts to execute value-oriented payment models, the lack of rigorous independent research studies impedes robust progress.

Donald Berwick Melinda Buntin Patrick Conway Raymond Vara Edward Prewitt head shots IHI forum panel on health care policy

New Marketplace

Signal or Noise? Navigating Health Care Policy — Part 2

A discussion from the Institute for Healthcare Improvement National Forum. Part 2 of a two-part series.

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