Feds reach target of tying 30 percent of Medicare payments to alternative payment models

In a ‘major milestone’ for the Affordable Care Act, 30% of Medicare payments are now done through alternative payment models.

Hardly a year after declaring its ambitious policy to tie reimbursement to quality of care, the U.S. Department of Health and Human Services declared on the day of March 3 that 30% of Medicare payments are now tied to alternative payment models, like ACOs.

The target was reached almost a year ahead of schedule, in accordance to HHS, which touts the fact that more than ten million Medicare sufferers are now getting higher-quality and more coordinated care.

In the month of January 2015, HHS set big targets to move thrity of Medicare to value-based arrangements by the end of the year 2016. With 121 latest ACOs declared in the month of January, along with higher contributor participation than hoped in other alternative payment programs, the agency claims it has already achieved it.

Its thanks in large part to Affordable Care Act-enabled initiatives like the Medicare Shared Savings Program and the CMS (Center for Medicare and Medicaid) Innovation, which permitted for the testing of latest cost- and quality-conscious APMs, stated HHS Secretary Sylvia Burwell.

“Making better the quality and affordability of care for entire Americans has always been a pillar of the Affordable Care Act, alongside extending access to health care,” claimed Burwell in a statement. “The law offers us the tools to put sufferers at the center of their care, improve quality and help make care more affordable over the long term.”

At HIMSS16 this week, more than 40,000 healthcare experts from around the country gathered in the state of Las Vegas, many of them here to learn about technologies and methods that can assist them to acquire the benchmarks essential for value-based payment models: interoperability tools for more coordinated and connected care, data analytics for population health, patient engagement technology and more.

“We reached this target in partnership with the thousands of contributors who collaborated with us in innovation,” claimed Patrick Conway, MD, deputy administrator for innovation quality and chief medical officer at CMS, in a statement. “It is in our common interest – as patients, contributors, businesses, health policies, taxpayers – to develop a health care delivery system that delivers better care; spends health care dollars more wisely; and makes people and communities healthier.”

There are 477 Medicare ACOs participating in the Shared Savings Program and the Pioneer ACO Model combined. In the year 2014, these programs produced a total net savings of $411 million. ACOs represent about 3 quarters of development toward the target declared today, in accordance to HHS, which says these gains will sustain to rise over the course of the year, with the initiation of the Comprehensive Care for Joint Replacement model and the Oncology Care Model in the year 2016.

Today’s assumptions and estimates were evaluated by the independent Centers for Medicare & Medicaid Services Office of the Actuary, which multiplied the number of Medicare beneficiaries in alternative payment models by the anticipated cost of their care, then comparing that figure to projected Medicare fee-for-service spending. As of the month January 2016, CMS estimates roughly $117 billion out of a projected $380 billion Medicare fee-for-service payments are tied to APMs.