Last December, the Trump Administration redesigned and set a new direction for the Shared Savings Program, which is Medicare’s main program for Accountable Care Organizations (ACOs) under “Pathways to Success.” Data on ACO performance in the program the first six performance years showed that, over time, those ACOs taking accountability for cost increases, or “risk,” performed better than those that did not. In fact, ACOs that did not take accountability for cost increases and only shared in savings nominally increased Medicare spending relative to their cost targets. The agency also found that ACOs led by physicians (which tend to be “low revenue” ACOs since they provide mostly outpatient services) performed better than ACOs led by hospital systems (which tend to be “high revenue” ACOs since they provide inpatient and outpatient services).
A closer look at the evolution of Medicare Advantage demonstrates that the private sector has proven to be a remarkable laboratory for innovation and progress in our health system’s core evolution—to align the payment and care delivery system with value and the outcomes we care about most for America’s seniors.
| One solution to most instances of surprise billing is to simply eliminate the possibility of being treated by an out-of-network emergency, ancillary, or similar clinician at an in-network facility. There are multiple ways to accomplish this, but one approach—sometimes called “network matching” or an “in-network guarantee”—would require these facility-based clinicians to contract with every health plan that the facility at which they practice accepts or, alternatively, choose to secure payment from the hospital rather than insurers. That requirement can be imposed either directly or, alternatively, indirectly by making joining an insurer’s network the only way clinicians can secure payment. |
Litigation continues in Texas v. Azar, a lawsuit over the constitutionality of the individual mandate and, with it, the entire Affordable Care Act (ACA). This post provides a brief update on the status of the case in the district court and the Fifth Circuit Court of Appeals, as well as some new positions taken by states in the lawsuit following the midterm elections. For now, the Texas litigation is on hold pending the end of the partial government shutdown, after which the case will proceed in the Fifth Circuit.
Many observers dismiss single-payer health care as a political non-starter , but this traditional view ignores an explosion of support for the idea in recent years. In one recent poll, over 70 percent of Americans said they would support “a policy of Medicare for All”, including 85 percent of Democrats and even 52 percent of Republicans. A subsequent poll asked “do you support providing Medicare for every American” and found nearly identical results, including majorities of support from respondents in the South, those who live in rural areas, and those who say they “lean conservative.”
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would overhaul the Medicare Shared Savings Program, an ACA program under which the vast majority of Medicare’s Accountable Care Organizations (ACOs) operate.