The Next Generation ACO Model
On March 10, 2015, the Center for Medicare & Medicaid Services announced a new classification of Accountable Care Organizations (ACO), known as the Next Generation model, which is aimed at providing coordinated, efficient, and high quality care to patients and reimbursing providers for the quality of care they provide, rather than the quantity of care they provide, to patients.
Toward that end, the Next Generation model is designed to build upon the successes of previous ACO models, while making some significant modifications. While the Next Generation model will use the same two-step algorithm as the Pioneer ACO model to determine beneficiary alignment, it will also offer the opportunity for the beneficiary to voluntarily align with a particular ACO. Next Generation ACOs will be able to control and predict their costs by building a guaranteed attributable patient base and engaging beneficiaries through the voluntary alignments that supersede the claims-based attribution assignment the beneficiary may have been designated by the algorithm - an attempt to fix a common complaint of the Pioneer ACO model. (Read more...)

Increased Scrutiny of Provider-Based Status Compliance
Provider-based status is a Medicare reimbursement status for hospitals and clinics that signifies the relationship between the main provider and a provider-based entity. A provider-based entity is eligible to bill under the Hospital Outpatient Prospective Payment System (OPPS) instead of the Physician Fee Schedule, which is significant since the OPPS incorporates a reimbursement component for hospital overhead that is greater than the overhead paid for services with a physician's office. As a result of the financial incentive concerns related to billing as a provider-based entity, the OIG has made it a Fiscal Year 2015 priority to focus parts of its auditing and review efforts on ensuring that the requirements for compliance with provider-based status are met. (Read more...)

The Rise of Start Up Healthcare Entities and Their Transformation of the Market
Consumer demand has long been an important driver of change in the healthcare industry. For example, through the 1900's, the average American spent $5 a year (roughly $110 today) on remedies that were futile attempts at healing the sick. However, with the establishment of clean medical facilities, antibiotics, and educated physicians, consumers were no longer only seeking care in extreme circumstances, but instead began seeking medical care to treat common illnesses. This change in demand resulted in a need for new tools, such as health insurance, to help cover the costs of care. Similarly, the Affordable Care Act has changed the market by further engaging consumers in the participation of their care while also developing new and more efficient ways to help provide high quality care. The result is a window of opportunity for innovative and new market entrants who wish to develop cutting edge technologies and a rapidly growing industry of healthcare startup companies with the ability to change the face and functions of the healthcare market. (Read more...)

Is AI the Cure for Cancer?
Research has expanded the use of Artificial Intelligence (AI) to further revolutionize healthcare, specifically in personalized cancer diagnosis and treatment. In April 2015, the International Business Machine Corporation (IBM) announced the development of a cognitive computing software called "Watson Healthcare Cloud," a cloud database where "providers and researchers can share and analyze health data for greater insights into trends to improve individual and overall patient outcomes." With its ability to process data, the Watson Healthcare Cloud has the potential to revolutionize cancer treatment in the near and distant future. (Read more...)