Rural Health
Resources by Topic: Reimbursement and payment models
Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements
Describes themes that emerged from workgroup meetings regarding the implementation of value-based care (VBC) models, with a focus on total cost of care arrangements. Outlines voluntary best practices and domains within VBC payment arrangements for health plans, facilities, clinicians, and VBC entities to consider during the design, implementation, and evaluation of VBC participation. Includes rural information and considerations throughout.
Date: 04/2024
Type: Document
Sponsoring organizations: AHIP, American Medical Association, National Association of ACOs
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Describes themes that emerged from workgroup meetings regarding the implementation of value-based care (VBC) models, with a focus on total cost of care arrangements. Outlines voluntary best practices and domains within VBC payment arrangements for health plans, facilities, clinicians, and VBC entities to consider during the design, implementation, and evaluation of VBC participation. Includes rural information and considerations throughout.
Date: 04/2024
Type: Document
Sponsoring organizations: AHIP, American Medical Association, National Association of ACOs
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Medicare Accountable Care Organizations: Past Performance and Future Directions
Summarizes research findings about Medicare accountable care organizations (ACOs) from recent peer-reviewed journals, official evaluations of Medicare ACOs, and research organization reports. Describes characteristics of certain ACOs associated with greater savings and factors that limit ACOs' ability to achieve net budgetary savings for the Medicare program. Identifies policy approaches that could increase savings for Medicare through ACOs and the Medicare Shared Savings Program. Includes a brief discussion of challenges facing ACOs in rural and underserved areas.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Budget Office
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Summarizes research findings about Medicare accountable care organizations (ACOs) from recent peer-reviewed journals, official evaluations of Medicare ACOs, and research organization reports. Describes characteristics of certain ACOs associated with greater savings and factors that limit ACOs' ability to achieve net budgetary savings for the Medicare program. Identifies policy approaches that could increase savings for Medicare through ACOs and the Medicare Shared Savings Program. Includes a brief discussion of challenges facing ACOs in rural and underserved areas.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Budget Office
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What Would Shifting To A Single-Dose HPV Vaccine Mean For Health And Access?
Discusses the potential impact of single-dose human papilloma virus (HPV) vaccines on health disparities for rural residents, lower socioeconomic status patients, men, and sexual and gender minorities. Discusses relief of cost barriers for health systems and vaccine shortages.
Author(s): Matthew Najarian, Amanda F. Petrik
Citation: Health Affairs Forefront
Date: 04/2024
Type: Document
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Discusses the potential impact of single-dose human papilloma virus (HPV) vaccines on health disparities for rural residents, lower socioeconomic status patients, men, and sexual and gender minorities. Discusses relief of cost barriers for health systems and vaccine shortages.
Author(s): Matthew Najarian, Amanda F. Petrik
Citation: Health Affairs Forefront
Date: 04/2024
Type: Document
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Evaluation of the Maryland Total Cost of Care Model: Progress Report
Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Medicare Payment for Rural or Geographically Isolated Hospitals
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Research Service
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Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Research Service
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Community Health Centers and Value-Based Payment
Discusses the role of Federally Qualified Health Centers and Rural Health Clinics, alternative payment models, and the challenges with implementing value-based payment.
Author(s): Janet Weiner
Date: 04/2024
Type: Document
Sponsoring organization: University of Pennsylvania Leonard Davis Institute of Health Economics
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Discusses the role of Federally Qualified Health Centers and Rural Health Clinics, alternative payment models, and the challenges with implementing value-based payment.
Author(s): Janet Weiner
Date: 04/2024
Type: Document
Sponsoring organization: University of Pennsylvania Leonard Davis Institute of Health Economics
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Rural Emergency Hospital (REH) Model Frequently Asked Questions
Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 04/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 04/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Primary Care Spending in Medicare Fee-for-Service: An Illustrative Analysis Using Alternative Definitions of Primary Care
Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to sex, race, age, insurance status, rural versus urban location, and more.
Date: 03/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to sex, race, age, insurance status, rural versus urban location, and more.
Date: 03/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Environmental Scan on Developing and Implementing Performance Measures for Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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March 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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