ACOsConsumers & PatientsPerformance ImprovementValue-Based Health Care
April 25, 2018

Four ACO Development Decisions That Will Impact Return on Investment 

“It’s not how you start, but how you finish” might be the way some ACOs must navigate a difficult path to success.  But for organizations planning a new ACO venture, that rocky path may be avoidable. The early days of ACO development are behind us, and ACO models to take on financial risk are now underway. Achieving a return on ACO investment has proven to be elusive for most providers. There is progress, but no victory yet in sight. So ACOs and industry watchers are searching for the keys that allow some ACOs to experience more success than others. Whether…
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
April 18, 2018

Unify ACO Quality and Cost Initiatives to Boost Long-term Results

Let’s face it. There’s a pretty low bar to meeting Medicare’s ACO Quality requirements. Most ACOs have achieved acceptable quality performance for Medicare Shared Savings Plans (MSSPs).  They have not, however, achieved the savings needed to be successful. ACO supporters point to the “Triple Aim” of achieving higher quality, cost savings and good patient experience through an ACO. To fulfill that tripartite goal, we must look past the hype and execute quality-cost initiatives that go well beyond CMS requirements. Recognize the Gap Between Quality Reporting Requirements and Quality Care Demonstrating quality and reducing costs are not mutually exclusive. While there…
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ACOsAdvanced Alternative Payment ModelsConsumers & PatientsMedical Decision-MakingValue-Based Health Care
April 11, 2018

ACOs Must Create Learning Environment for Physicians to Be Partners in Change

The idea behind ACOs sounds simple enough: Build a network of primary care physicians, specialists, hospitals and other health care organizations that share risk and responsibility to provide coordinated care for each patient. Medicare or private insurers offer financial incentives to ensure that ACOs provide quality treatment while limiting unnecessary spending. Primary care physicians serve as key liaisons for each patient’s care. But ACO reality is much more complex and daunting. Shared savings have proven to be elusive. Quality benchmarks do not always accurately measure what’s medically relevant. Patient attribution to specialists, rather than primary care physicians, skews costs. Nonetheless,…
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ACOsAdvanced Alternative Payment ModelsFuture of Health CareValue-Based Health Care
April 4, 2018

ACO Economics 101: Optimize the Physician Network For Patient Choice

The inaugural MIPS 2017 submission period closed in a fog of uncertainty. The demise of MIPS looms on the horizon, with little discussion of opportunities for improvement. Heath and Human Services Secretary Azar has advocated for removing the quality reporting component of MIPS, while the Medicare Payment Advisory Committee (MedPAC) recommended scrapping MIPS altogether and pushed for a transition to Alternate Payment Models . Note that neither of these recommendations advocate a return to a simple Fee for Service model—it is not sustainable financially. Value-Based Health Care is here to stay, but Advanced Alternate Payment Models (AAPMs) with financial risk are…
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