Shedding Light on Alternate Payment Models

Posted in Accountable Care Organizations (ACOs), CMS, Coding Accuracy, Medicaid, Medicare

The shift to value in healthcare is no easy feat. While the Centers for Medicare and Medicaid Services (CMS), accountable care organizations (ACOs) and healthcare systems are all working towards it, true success requires a commitment to collaboration, communication and transparency.

That’s why earlier this month, the National Association of ACOs (NAACOS) publicly called on CMS to be more transparent in their process as it relates to developing alternative payment models. In the past several years, the agency has been known to make changes in the middle of a performance year without gathering much communication or input from key stakeholders. ACO advocates claim that clear communication and greater predictability will help the industry move toward value more quickly.

Every shift put into place by CMS can have a significant impact on operational and financial performance for ACOs that are striving to achieve the triple aim in health care – better quality, better value and greater satisfaction. ACOs understand that performance-based risk also brings the potential for greater reward, but the transition from a fee-for-service model is a delicate balance that requires significant planning, evaluation and forecasting – a balance that can’t shift on a whim.

Hopefully, the CMS Innovation Center will recognize the monumental effort that ACOs are making in supporting our nation’s transition to a healthier healthcare payment system and commit to greater transparency as requested.

In the meantime, GeBBS Healthcare Solutions offers a variety of risk adjustment services to help payers and risk-bearing providers stay head of the curve. GeBBS iCode Risk Adjustment solution can support an ACO’s need to predict costs for future years through a thorough coding review. GeBBS’ advanced technology and in-depth understanding of risk models and value-based care – combined with reliable, accurate coding solutions can help ACO’s gain better predictability during what is often an unpredictable shift toward payment reform.