Tag Archives: Payment Reform

CMS’ 2014 ACO Results Are In. Conclusion: Implementing New Payment Models Are Challenging

As a key part of the ACA. CMS made healthcare payment innovation a cornerstone of the bill.  After a few years of implementing this, the results are in.  For 2014, CMS had a $3 million loss instead of savings.

This goes to show healthcare innovation and reform especially payment model innovations need a bit more time.  As the saying goes, an aircraft carrier can’t turn on a dime.  With the complexity and size of the US healthcare system, we are truly a massive organization that needs a wide turning radius.

Payment Reform Initiative in Action: Results from the Frontline in Colorado

A growing area in healthcare is the rise in alternative payment methodologies.  Gone are the days of primarily fee-for-service medicine.  The State of Colorado has recently published the results of an Accountable Care Collaborative (some folks may know this from the other name, Accountable Care Organization or ACO) in a legislative report.  About half of their Medicaid members were enrolled in a Patient-Centered Medical Home where PCPs and dedicated case managers coordinated the medical care as well as non-medical care (e.g. transportation to doctor’s offices, homes sufficiently outfitted w/hand-rails if member is prone to falls).  Result?  The state saved approx. $44 million in 2012.  However, the state invested around $38 million in total program costs including administrative fees.  Hopefully, a good portion of these were up-front costs and the vast majority of these dollars should decrease in subsequent years.

Read more about this here.