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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ACOsRiskValue-Based Health Care
July 14, 2021

New ACO Playbook: 3 Approaches to Scale Up Data Sufficiency for Value-Based Care

Like every health care organization, your struggles with data may appear never-ending. Like money, there never seems to be enough of it. In this article we’ll take the mystery out of how to realistically gauge your data needs, 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 Needs Have Scaled Up with Value-Based Care When providers were focused on meeting patient volume targets, operations systems like billing and scheduling provided an adequate basis for tracking volume and revenues.…
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ACOsEpisodes of CareValue-Based Health Care
June 17, 2021

New ACO Playbook: How ACOS Can Transform Clinical Care for Diabetes

An illuminating article about ACOs, featuring current and former MedPAC chairs’ perspectives, argues that savings have been constrained because too much is beyond ACOs’ purview to manage. Examples include both external restrictions (the exclusion of prescription drugs and provider fee payments from ACO control) and internal cultural or economic barriers (conflicts of interest that make it difficult to reduce hospitalization revenues). ACOs Are Caught Between Roles as Provider and Payer The current ACO model is, indeed, challenging. Blending both provider and payer functions is fraught with conflict. But the provider-directed model was supposed to function closer to the actual delivery…
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ACOsAPM Performance PathwayMerit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
May 24, 2021

New ACO Playbook: To Show Standout Performance, ACOs Must Rethink Quality

The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority of ACOs meet quality measures, with 92 percent passing the qualification for shared savings in 2019. But is quality performance a distinguishing feature that ACOs can use competitively—and sustain the payment model’s long-term prospects? To earn permanency and competitive advantage, ACOs must show that the…
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ACOsFuture of Health CareValue-Based Health Care
May 13, 2021

New ACO Playbook: Three Touchstones for ACO Viability

Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force them into Risk. There are significant flaws to tying ACO structure to the viability or value of the model, however, or in discrediting ACOs which don’t yet produce those savings but may have other important characteristics for the long term. In a more competitive health…
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ACOsEpisodes of CareFuture of Health CareRiskValue-Based Health Care
April 29, 2021

New ACO Playbook: Can Coordination of Care Save Enough Money to Save ACOs?

Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many others, however, dismiss the small proportion of savings—at a few percentage points—relative to total Medicare spending. The previous CMS administration was clearly dubious about the shared savings model. It favored payment models that put providers at financial risk to increase cost reduction incentives, even though…
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ACOsRiskValue-Based Health Care
April 14, 2021

Why ACOs Need a New Playbook

A lot has happened in health care since 2012, when final rules permitted provider-organized ACOs to be the driving force of Value-Based Care under the 2010 Affordable Care Act (ACA). As we pass the ACA’s eleventh anniversary, a dwindling number of Medicare Shared Savings Program (MSSP) ACOs are entering a new phase marked by higher expectations and more difficult economics. To succeed in this challenging environment, ACOs will need different tools going forward than first contemplated, because of competition, both from providers under new value-based payment models and from Medicare Advantage plans. They also face more skepticism. Although rule changes…
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ACOsBehavioral HealthDirect ContractingRiskValue-Based Health Care
April 5, 2021

5 Value-Based Behavioral Health Strategies for ACOs and Medical Group Models

For ACOs and Direct Contracting Medical Groups adopting value-based payment models, behavioral health is often overlooked. But your patients’ unmet behavioral health issues are a big cost driver for emergency care and inpatient admissions, and they compound risk factors in disease. They also influence your patients’ adherence to treatment plans. You may believe this is a problem you can’t resolve because behavioral health is beyond the boundaries of your participating network. Even so, you need to be aware of a significant emerging trend: integrating behavioral health in primary care. The difference between physical medicine’s approach to disease versus behavioral health…
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ACOsDirect ContractingFuture of Health CarePrimary Care PracticesValue-Based Health Care
March 18, 2021

With Competing Payment Models on Hold, What’s the Future for ACOs?

When CMS first announced new primary care payment models in April 2019, ACOs understood that their future might be threatened by competition for both physicians and patients. If medical groups could independently contract with Medicare under these models, they would have the advantage of greater control over their physician network, referral arrangements, and clinical decisions. The Value-Based primary care models of Direct Contracting (DC) and Primary Care First (PCF) were presented as a strategy to fortify primary care and independent practitioners. By combining prospective payment, quality monitoring, and incentive pools for lowering admissions and total costs, providers could potentially reap…
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COVID-19Future of Health CareRacial Inequities in Health CareWomen and Health Care
January 25, 2021

Why Health Equity Will Be Measured in Value-Based Health Care

After the first wave of COVID-19 case numbers and deaths in Spring 2020, it was Mayor Lori Lightfoot of Chicago who broke the story of how the virus was distinctly ravaging Black and brown communities with higher hospitalizations and deaths. In Chicago, alone, Black residents were dying from COVID-19 at six times the rate of other Chicagoans. While the virus has been unsparing across the board, there is a tragic trifecta—people who are older, or of color, with serious underlying conditions, are dying in greater numbers, with a disproportionate percentage of deaths afflicting underrepresented groups. COVID-19 is not unique in…
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