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Rural Healthcare Payment and Reimbursement – Resources

Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.

AHIP Value-Based Care Workgroup
Presentation slides from a January 23, 2024, presentation to the AHIP Value-Based Care Workgroup. Provides an overview of rural healthcare. Discusses rural-relevant engagement and rural value-based care and payment model design considerations. Highlights examples of rural providers successfully participating in value-based payment programs, including Medicare Shared Savings Programs and Accountable Care Organizations (ACOs).
Date: 01/2024
Type: Presentation Slides
Sponsoring organization: Rural Health Value
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States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
Recording of a January 29, 2024, webinar regarding the Centers for Medicare & Medicaid Services' States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Discusses the AHEAD Model's timeline, key elements, opportunities, and requirements from a rural perspective. Identifies potential implications for rural hospital and primary care participation.
Additional links: Presentation Slides
Author(s): Clint MacKinney
Date: 01/2024
Type: Document
Sponsoring organization: Rural Health Value
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The Effects of Medicare Advantage on Rural Hospitals With St. Bernards Healthcare
Podcast episode featuring a discussion with Chris Barber, president and CEO of St. Bernards Healthcare, which serves communities in Arkansas and Missouri. Describes how certain Medicare Advantage plan practices can create problems for rural hospitals, health systems, and patients.
Date: 01/2024
Type: Audio
Sponsoring organization: American Hospital Association
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2024. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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What States Can Learn from Maryland's Experience with Hospital Global Budgeting
Podcast episode exploring lessons learned from Maryland's hospital global budgeting model. Includes a discussion on small and rural hospitals' financial sustainability and their involvement in the model, as well as comparisons to the Pennsylvania Rural Health Model and the Vermont All-Payer Accountable Care Organization (ACO) Model.
Date: 01/2024
Type: Audio
Sponsoring organization: Mathematica
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January 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, outpatient dialysis services, hospice services, skilled nursing facility services, home health agency services, and inpatient rehabilitation facility services. Discusses status reports on ambulatory surgical centers, Medicare Part D, and the Medicare Advantage program, as well as policy options for standardized benefits in Medicare Advantage plans. Includes rural references and considerations throughout.
Date: 01/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluation of the Next Generation Accountable Care Organization (NGACO) Model: Final Report
Sixth and final evaluation report on the Next Generation Accountable Care Organization (NGACO) Model. Summarizes findings from across all six performance years (2016-2021) and explores how participating entities responded to the model and how they did or did not achieve model goals. Presents information on cumulative model-wide impacts on Medicare spending, utilization, and quality of care; variations in model outcomes by organization characteristics; spending patterns of beneficiaries served by NGACOs; population health strategies and pathways to reduced spending; lessons learned; and more. The appendices include data on community and beneficiary characteristics, including rurality.
Additional links: Findings at a Glance, Technical Appendices
Date: 01/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Alternative Payment Models in the Quality Payment Program as of December 2023
A set of three tables that list brief information about Alternative Payment Models (APMs) that the Centers for Medicare and Medicaid Services (CMS) operates or has announced, as of December 2023. Identifies Advanced APMs, Merit Based Incentive Program (MIPs) APMs, and Other Payer Advanced APMs, which include Medicaid Other Payer Advanced APMs, Medicare Health Plan Payment Arrangements, and commercial payment arrangements.
Date: 12/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Independent Evaluation of Comprehensive Primary Care Plus (CPC+): Final Annual Report
Reports on the Comprehensive Primary Care Plus (CPC+) model, a CMS primary care payment and delivery reform effort that ran from 2017-2021. Outlines key findings from the model, including CPC+ supports to practices, care delivery changes made by practices, impacts on outcomes for Medicare fee-for-service beneficiaries, and implications for primary care models. Describes the experiences of payers, practices, health IT vendors, and patients. Includes rural references throughout.
Additional links: Appendices to the Final Report, Volume 1, Appendices to the Final Report, Volume 2, Findings at a Glance
Date: 12/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Advancing Value-Based Payment Policies Relevant to Rural Areas – Continued Challenges and New Opportunities
Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 12/2023
Type: Document
Sponsoring organization: Rural Health Value
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Last Updated: 2/23/2024