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June 28, 2018

ACO roundup: Mayo Clinic teams up with BCBS of Minnesota on value-based care

Daily Briefing
    • Mayo, BCBS of Minnesota team up on value-based care. Mayo Clinic and Blue Cross and Blue Shield of Minnesota are entering a five-year contract to streamline care for patients. The contract will lift certain prior authorization requirements for Mayo patients, expand value-based care coordination between the two organizations, establish a collaborative governing board to assess coverage of emergent medications and technology, and foster "guided care" services, which refers to when an insurer aids members with complex health issues navigate the health care system. The contract, which takes effect in 2019, will run through 2023.

    • CMS bolsters monitoring of Medicaid managed-care plans. CMS on Tuesday announced three new initiatives designed to improve the integrity of Medicaid programs through increased transparency, more robust data, and new analytics tools. As part of the effort to ensure Medicaid's integrity, CMS said it will adopt a new approach to auditing state claims for federal matching funds and medical loss ratios (MLRs) that places a greater emphasis on program integrity. In addition, CMS said it will begin auditing state beneficiary eligibility decisions in states that HHS' Office of Inspector General has identified as "high risk" for eligibility determination issues. CMS also announced plans to test a pilot program that aims to make it easier for health care providers to enroll in federal health care programs.

    • Is the Stark Law hurting your shift to value-based care? CMS wants to know. CMS last week published a request for information to solicit industry feedback on how the agency could change a federal anti-kickback law to better account for value-based care models. Hospital and physician groups have argued that the Stark Law—which bans physicians from referring Medicare beneficiaries they are treating to entities in which they have a financial stake—can inhibit providers' transition toward value-based payments, as it could punish a doctor for referring a patient to a provider within the doctor's ACO, for which the doctor benefits from shared savings. Stakeholders have until Aug. 24 to submit comments.  

    From Advisory Board:

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    • The 2018 MIPS cost category—decoded. Join us on Thursday, August 2, at 3:00 p.m. ET, to learn the metrics included in the 2018 MIPS cost category, how providers' scores will be calculated, and strategies for improving performance.

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    • How to succeed under Medicaid risk. Join us on Tuesday, August 14 at 1:00 p.m. ET for a live panel discussion with population health, health plan, and Medicaid strategy experts from within Advisory Board to learn about key considerations for taking on Medicaid risk and setting up the right infrastructure to manage the population.

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