Aligning Institutional Research Investment with Clinical Strategy: A Future-Focused Approach

MassHealth has created a Technical Assistance program enabling accountable care organizations and community partners to receive funding for initiatives that strengthen their capabilities to support MassHealth members. Learn how to initiate projects in this post.

The first performance period for the CMS Bundled Payments for Care Improvement Advanced (BPCI-A) program began on October 1, 2018. Now with the program having started, if you are a BPCI-A participant, you may be wondering how you can operationalize your bundled payment initiatives to position your organization for success.

In a ruling called “Pathways to Success,” the Centers for Medicare & Medicaid Services has overhauled the Medicare Shared Savings Program (MSSP), accelerating the path to financial risk for MSSP ACOs.

In the closing days of 2018, CMS released its 2019 final rule for the Medicare Shared Savings Program (MSSP), thereby finalizing several significant program changes that CMS had previously proposed in August 2018.

The Centers for Medicare & Medicaid Services (CMS) finalized key updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS), the Ambulatory Surgical Center Payment System (ASCPS), and the Physician Fee Schedule (PFS) that will be effective January 1, 2019, with additional changes to be implemented in 2021.

On October 25, President Trump announced his plan to lower prescription drug prices. Under the plan’s new proposed payment system, the Centers for Medicare & Medicaid Services (CMS) will launch a five-year pilot program—the International Pricing Index (IPI) model—that will allow Medicare to pay less for select Part B drugs when a lower international price is available.

A forward-thinking financial model can help hospital leaders better predict and balance potential gains and losses from incentives, penalties, volume changes, and other factors related to value-based payment.

To thrive in the increasingly disruptive healthcare environment of the future, accountable care organizations (ACOs) will need to develop a strategy that is data driven and consumer focused. It is becoming clear that, to enjoy long-term financial success, ACOs must position themselves to assume greater risk/reward models.

The ECG team has been chosen as a preferred vendor for the MassHealth DSRIP Technical Assistance (TA) Marketplace. The MassHealth TA Marketplace is a product of MassHealth—the Commonwealth of Massachusetts’ Medicaid and Children’s Health Insurance Program—and contractor Abt Associates.