Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.


May 17, 2018

ACO roundup: MGMA launches coalition to aid independent physicians' shift to value-based care

Daily Briefing
    • Oscar Health reports first quarterly profit. Oscar Health has posted a profit for the first quarter of 2018—the first quarterly profit the health insurer has reported since it launched in 2013. Overall, the insurer in the first quarter reported $7.4 million in net profit and $312 million in premium revenue, putting it on track to generate an estimated $1 billion in premium revenue for 2018 as a whole. According to Modern Healthcare's Shelby Livingston, the profit suggests that Oscar Health's strategy of establishing narrow networks via collaborations with major hospital systems, such as Cleveland Clinic and Mount Sinai Health System, may be successful.

    • Maryland's radical all-payer model was just extended through 2023. Maryland Gov. Larry Hogan (R) on Monday announced that CMS has approved the state's request to extend and expand its all-payer model. CMS and Maryland in 2014 established a five-year deal under which all payers in the state set annual global budgets for hospitals to cover both inpatient and outpatient care in the hopes that fixed, predictable revenues would give hospitals flexibility to invest in care improvements and make care more valuable for patients and payers. Under the expansion Hogan announced on Monday, the all-payer model starting Jan. 1, 2019, will also apply to some doctors' visits and other outpatient services, such as long-term care. Community health care providers will be able to choose whether they want to participate in the model.

    • New coalition helps independent physicians transition to value-based models. The Medical Group Management Association (MGMA), in collaboration with five other physician organizations, has launched a coalition aimed at promoting policies that facilitate independent physicians' transition to value-based payment models. Specifically, the coalition—called the Partnership To Empower Physician-Led Care—will advocate for physician-led alternative payment models, promote policies aimed at boosting consumer choice and increasing competition, and generate new opportunities for physicians in Medicare Advantage and other commercial markets. In addition to MGMA, the coalition includes Aledade, the American Academy of Family Physicians, the California Medical Association, the Florida Medical Association, and the Texas Medical Association's PracticeEdge.

    From Advisory Board:

    • Everything you need to know about the proposed IPPS rule. Join us on Tuesday, May 22 at 3:00 p.m. ET, to get the details of the FY 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule, including proposed changes to rates, MS-DRG groupings, and inpatient quality initiatives.

    Register Here

    Register Here

    Register Here

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.