Posts Tagged ‘Wellmark Medicare ACO’

2015 Healthcare Headlines: Top Stories Trace Route to Value-Based Reimbursement and Care

December 28th, 2015 by Patricia Donovan

Month by month, the industry's top stories confirmed that value-based innovations and collaborations are here to stay.

A look back at the year’s top healthcare stories captures the industry’s commitment to enhance the quality and efficiency of care delivered while reining in cost. Nearly all of HIN’s most-read stories fell into one of two categories: announcements of new value-based models or pilots, or results from existing quality-focused initiatives.

Here are the stories that captured the attention of healthcare executives in 2015:

HHS Announces Timetable, Goals for Medicare Value-Based Reimbursement
Medicare kicks off 2015 with the rollout of an ambitious multi-year agenda for a shift to value-based reimbursement and alternative payment models.

Cigna Collaborative Care Reduced Avoidable ER Visits by 16 Percent
The February release of Cigna’s second-year results from a collaborative care initiative with Granite Healthcare Network documented significant progress in improved health and affordability.

2015 Hospital Market Will Hasten Transition to Value-Based Payment Business Model
The early 2015 economic outlook for the hospital industry continued to favor the largest, most geographically diverse health systems in the market, according to this January 2015 forecast from BDC Advisors.

Medicare Discharge Planning Proposed Rule: More Focus on Patient Preferences, Follow-Up Care and Communication
CMS proposed in October a revision of discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs.

Senate’s Repeal of Medicare Sustainable Growth Rate Strengthens Move Toward Value-Based Physician Reimbursement
April 2015 saw the U.S. Senate’s landmark repeal of the Medicare Physician Payment Reform Bill, otherwise known as the Sustainable Growth Rate (SGR), a mechanism used to calculate Medicare payments to physicians.

One-Fifth to Launch ‘Next Generation ACO’ in 2015
Twenty percent of healthcare organizations plan to participate in CMS’s new ‘Next Generation ACO’ model in the coming year, according to 2015 Accountable Care Organization metrics compiled in May.

8 Wellmark Medicare ACOs Saved $17 Million in 2014, Boosted Quality by 8%
September saw the release of Wellmark Blue Cross and Blue Shield’s 2014 Accountable Care Organization (ACO) Shared Savings model data, in which eight participating ACOs improved their overall quality scores by 8 percent and saved more than $17 million during 2014.

CMS Launches New ACO Dialysis Model
CMS announced in October its Comprehensive ESRD Care (CEC) Model, designed specifically for beneficiaries with ESRD and built on lessons learned from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program.

Final Rule for Joint Replacement Bundled Payments Favors Composite Quality Score
In November, CMS finalized its Comprehensive Care for Joint Replacement (CJR) model, set to begin on April 1, 2016, which will hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service beneficiaries for hip and knee replacements and/or other major leg procedures from surgery through recovery.

Geisinger Pilots Patient Experience ‘Warranty’ for Select Surgeries
The Pennsylvania health system generated headlines in November with the launch of its innovative ProvenExperience™ warranty, a program that keeps the patient experience front and center by offering refunds to patients undergoing select surgical procedures whose expectations weren’t met based on kindness and compassion.

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