Roji Intel Blog

Theresa Hush 0
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ACOsFuture of Health CareRiskValue-Based Health Care
November 17, 2021

Supercharge Your Way to Value-Based Care

Whether you are an ACO, a health system considering value-based payment, or a medical group weighing your options for Value-Based Care, Roji’s new eBook, Supercharge your ACO for Top Value, has the strategies you need to reduce the cost of care and get clinician backing for innovation. The health care market’s reconfigured landscape puts ACOs—and health care organizations still in a Fee-for-Service contracting circuit—in danger of losing their ability to capture the savings from more effective and efficient health care driven by data, strong physician buy-in, and direct-to-consumer marketing. Medicare Advantage and equity-backed medical groups are competing with traditional providers…
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Dave Halpert 0
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Merit-Based Incentive Payment System (MIPS)MIPS Value PathwaysQuality Payment ProgramValue-Based Health Care
November 10, 2021

The 2022 CMS PFS and QPP Final Rule: A Warning Shot to Provider Holdouts of Value-Based APMs

CMS has released the 2022 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule, and the message of these 2,414 pages is clear: CMS wants to push providers into value-based care arrangements. That intent was foreshadowed by the Proposed Rule released over the summer, which confirmed our predictions of trends under the Biden administration. Specifically, we saw a push to move providers into value-based care arrangements with an emphasis on closing the health equity gap, and a shift toward measuring progress through enhanced quality reporting requirements within a value-based care arrangement. To that end, in the Final Rule CMS…
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Theresa Hush 0
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ACOsEpisodes of CarePopulation HealthValue-Based Health Care
October 20, 2021

New ACO Playbook: How to Supercharge Your ACO

Throughout the last decade of ACO development, many have struggled to identify what actually makes ACOs successful. Analyses have been fraught with conflicting conclusions. Studies have tagged type of ownership (hospital-based vs. physician-led), geographic region or urban-rural factors, primary-care-only versus specialty participation, ACO payment model type, patient volume, and operations strategies as links to success or failure. While such studies are often insightful and worth considering, they won’t pass scientific muster. That’s because ACO success does not depend solely on an ACO’s organizational attributes. Success in Your ACO Business Is Driven by Vision and Execution Like every business trying to…
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Theresa Hush 0
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ACOsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 6, 2021

New ACO Playbook: Seven Keys to Expanding ACO Savings—and Market Share

At the beginning of this series, we laid out a basic tenet: As shared savings plan ACOs, you need to do as well or better at lowering costs than competing value-based payment models. Otherwise, your resources and support will dwindle in favor of more promising avenues to control Medicare spending, and competition will stifle your growth. We’ve examined the competition and what they offer physicians to succeed in Risk and to attract patients. The bar is high. Medicare Advantage Plans, equity-backed practices, and Management-model ACOs like Aledade have changed the playing field for physician participation and growth. ACOs Have Lost…
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Theresa Hush 0
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ACOsSpecialty ServicesValue-Based Health Care
August 25, 2021

New ACO Playbook: 3 Strategies to Tackle Hidden Costs of Specialty Care

Your ACO’s most significant costs may seem obvious. CMS and most ACOs have put an enormous emphasis on reducing utilization of hospital facilities and nursing home care to control costs. But your real key to cost reduction is knowing what drives avoidable admissions and stays in the first place. And with 50-60 percent of costs attributed to specialty physicians, that is where you need to start. Specialists are—and should be—involved in your most complex patients’ care. Those specialists will benefit from a collaborative involvement in cost data. And both your ACO and your patients will benefit from better and more…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
August 24, 2021

Cost Savings Aren’t the Only Objective for ACOs: Growth Matters, Too

Keeping within expenditure limits is a top priority for most ACOs for Medicare. That makes sense. Savings are the main distinguishing feature of an ACO arrangement, as opposed to straight Fee-for-Service reimbursement. ACOs that accept downside risk can’t afford to exceed the expenditure target. It’s in their best interest to create initiatives to cut costs and control expenses—especially for services outside the ACO, such as post-acute care. But a cost strategy only focused on trimming expenses will likely fail the ACO in the long run. Why? Medicare ACOs face an annually decreasing expenditure limit that mandates them to lower costs…
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Theresa Hush 0
4
ACOsFuture of Health CareRiskValue-Based Health Care
August 19, 2021

New ACO Playbook: Three Ultimate ACO Strategies to Keep Physician Practices Onboard

ACOs have zealously protected their favored status under Medicare Value-Based payment models, ensuring enough time for organizations to feel comfortable with financial risk and make investments in infrastructure. But if your own ACO is losing physicians to new equity-financed networks or to hospitals consolidating practices, more time does not help you. Primary care physicians are being picked off by your competition, and their patients go with them. Private equity firms and venture capital-funded groups have gained significant ground in acquiring physician practices, with mergers and acquisitions hitting record highs in 2019 and 2020, and accelerating in 2021. Equity firms and…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
July 29, 2021

Five Important Health Care Trends that Consumers Should Track

In the world of health care, change is never-ending. Politics, government regulation, scientific advancement, technology, and the economics and financing of health care foster shifts to reshape how care is delivered and how much it costs. Many of these shifts are completely invisible to us as health care consumers. But they also drive what is happening to and around us, determining availability and affordability of physicians or other services. This came home to me last month when we had friends over for dinner, and the conversation turned to our work. I mentioned Accountable Care Organizations and got blank stares. The…
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Dave Halpert 0
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ACOsMerit-Based Incentive Payment System (MIPS)Quality Payment Program
July 19, 2021

The 2022 CMS PFS and QPP Proposed Rule: 7 Things to Know

After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity gap and a lack of useful data available to healthcare consumers as major challenges to overcome. We’re highlighting the seven biggest takeaways from the newly proposed Rule. Here’s the short version: The bar is higher, with substantial MIPS scoring changes ahead, and providers and organizations…
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Theresa Hush 0
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Data-sufficiency-for-acos
ACOsAdvanced Alternative Payment ModelsAPM Performance PathwayRiskValue-Based Health Care
July 14, 2021

ACOs: Scale Up Data to Achieve APM Success

Last updated July 27, 2022 More data is required for ACOs, now that Alternative Payment Models have moved to high gear. In this article we’ll take the mystery out of how to realistically gauge your data needs and scale up data, so that your ACO can be successful. We'll show you how to identify the links between what you want to accomplish as an ACO or medical group in value-based payment models and those data requirements, and help you target your data efforts.  Data will drive your analytics, and analytics will fuel your interventions to produce better outcomes and cost…
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