the coral BLOG
Your source for the latest health care news. Get insights on industry trends and policy updates from Coral Health Advisors.
Key Takeaways from the CY2025 Physician Fee Schedule Proposed Rule
This year’s proposed rule covers a lot of ground—pressing full steam ahead on eCQMs for ACOs, introducing new payment codes for advanced primary care, and seeking more open-ended comment on a higher risk track of MSSP.
MSSP Proposed Rule to Address Anomalous Catheter Billing in 2023
CMS proposed a rule to exclude certain catheter-related DME claims from 2023 financial calculations for Medicare Shared Savings Program ACOs due to suspected billing fraud. The 30-day comment period ends July 29, 2024, and if finalized, the rule may delay financial settlement reports by six weeks.
Five Takeaways from the Second Annual CMS Health Equity Conference
Coral Co-Founder, Melissa Cohen, and Senior Advisor, Maria Alexander, attended the CMS Health Equity Conference on May 29-30, 2024. Read more to find out what stood out to us over the two-day conference.
Increasing Organ Transplant Access model (IOTA)
The proposed model holds selected transplant hospitals accountable through upside and downside performance-based payments and includes requirements to address health equity and transparency.
Transforming Episode Accountability Model (TEAM)
The Centers for Medicare & Medicaid Innovation (CMMI) just announced a new mandatory model via the Hospital Inpatient Prospective Payment System (IPPS) proposed rule, the Transforming Episode Accountability Model or TEAM.
The ACO Primary Care Flex
The Centers for Medicare & Medicaid Services (CMS) recently announced the ACO Primary Care Flex Model (ACO PC Flex), a new initiative that layers primary care capitation on top of the existing Medicare Shared Savings Program (MSSP).
CMS' Innovation in Behavioral Health (IBH) Model
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative new model to support Medicaid and Medicare populations with behavioral health needs. The Innovation in Behavioral Health (IBH) Model was designed to enhance mental health and substance use care for individuals grappling with moderate to severe mental health conditions and/or substance use disorders and bridge the gap between behavioral and physical health.
Unveiling the Transforming Maternal Health Model
In a bid to reshape maternal healthcare and address alarmingly high rates of poor maternal health outcomes (as compared to other high-income countries), the Centers for Medicare and Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model on December 15, 2023. This bold initiative spans a decade, with the goal of improving outcomes for pregnant and postpartum women, all while tackling disparities in access to care and treatment offered.
Did GPDC Save Medicare Money or NOT?
Breaking down the PY2022 GPDC (Global and Professional Direct Contracting) financial reconciliation results and model evaluation
Reconciling the savings paid and losses recouped as part of an Innovation Center model with evaluation findings that differ has often been painful—but important. Learning to unpack success and statistical significance, and taking the best lessons forward requires effort. In this Q&A with Coral Co-Founder Melissa Cohen, we explore what happened, what conclusions are safe to draw, and what we can all learn from it.
Coral’s 5 Takeaways from naacos
The National Association of ACOs (NAACOS) held its annual fall conference in DC last week and you could feel the energy was up. They had a record turnout of over 700 attendees - ACO participants, enablers, consultants, and professionals focused on all things accountable care. Coral Health Advisors was in attendance and came away with 5 key impressions to share.
Value’s Future is alignment
When we know something works, we ought to do it. But what if we think we know what works, or that it could work if we did enough of it?
This is the paradox of testing and scaling that has been value-based care for the past decade. Recent reports highlight the growing importance to providers of payer alignment to support implementation of value-based care and population health.
to qp, or not to qp - That is Still the Question
Coral did not create this witty title. Another consulting firm wrote a blog with a similar title when the Quality Payment Program (QPP) first emerged with the concept of Qualifying Participants (QPs) in 2017. The idea behind QPP was to give special status to those entities moving into downside risk and taking accountability for the cost and health outcomes of their patient population. By virtue of being a QP, participants were exempt from the Merit Based Incentive System (MIPs) - a comprehensive quality reporting framework that determined the way all other physicians were paid. This was the plan for continuing to encourage the move away from fee-for-service (FFS) and towards value. And every year, the Physician Fee Schedule (PFS) updates QPP including what it takes to be a QP and the requirements for MIPs.