ACO ReportingFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
January 10, 2017

Can Health Care Stay the Course of Reform Amidst Uncertainty?

With the new year finally here, health care organizations need to know: How should you proceed amidst uncertainty about Medicare policy, including Value-Based and Risk programs initiated by the Obama administration? In the crosshairs are the new, complex Quality Payment Programs under MACRA, including both MIPS and Alternative Payment Models (APMs) such as ACOs. Although MACRA had bipartisan support in the 114th Congress, it was the Affordable Care Act (ACA) that created the foundation for ACOs and other Value-Based programs. As the new Congress hurtles toward ACA repeal, the landscape for all of health care is murkier than ever. The…
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Future of Health CareMACRAValue-Based Health Care
January 3, 2017

Onward to 2017 as Roji Health Intelligence

  It’s been a momentous year in health care, with significant changes on the way for 2017. “Patient Empowerment” and cost shifting to the consumer are gaining political currency in Washington. MACRA is looming on the horizon, with the coming year being the first under the Final Rule for measuring performance. Health care organizations have significant strategic decisions to make as we move more intensively through an era of Value-Based Health Care and into Risk. Patients, too, will face serious questions about health care coverage and how to find accurate, comparative information for making choices about providers and networks. It…
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Future of Health CareMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
December 20, 2016

New Year’s Prediction: More Cost Sharing for Patients Means Problems for Providers

A year ago we reported on the trend in shifting health care costs to the consumer through higher deductibles, copayments and premium sharing. Fast forward to 2017: expect to see “financial accountability” for patients vastly increase, as health care costs continue their relentless rise and the public policies that support premium subsidies, Obamacare, Medicare and Medicaid expansion, research and innovative provider-based models are weakened or reversed. In general, the politics of the moment are ushering in simple economic concepts: Reduce the complexity, cap costs, minimize bureaucracy. When government or employers contemplate giving patients a fixed contribution for health care, possibly through…
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Future of Health CareRoji Health Intelligence
December 13, 2016

ICLOPS is Changing Its Name to Roji Health Intelligence

We all know that health care is at a crossroads. Regardless of any new directions that national policy will take, providers will be under even greater pressure to reduce costs. We expect that providers will be under financial risk, and patients will bear more costs. What remains constant is the need for guidance and data to navigate a successful path to better health. ICLOPS is reinforcing its commitment to help providers to succeed on this path, through its strategic consultation and technology. To reflect what lies ahead, ICLOPS is also changing its name on January 1, 2017, to Roji Health…
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Future of Health CarePatient EmpowermentResearch
December 6, 2016

A Populist’s Wish List for Patient Empowerment

Health care turmoil of the last 10 years was wild enough, but the ride ahead promises to be even wilder. News and social media are swirling with proposals to “reset” health care. Among the dizzying array of possible scenarios, one idea is gaining traction: patient “empowerment.” It will, without doubt, be a prominent call-to-arms in the months ahead. But, what exactly is patient empowerment? The newly branded concepts presented in health care proposals are murky and incorporate everything from patient responsibility for lifestyle changes and following treatment plans (patient “compliance”) to greater financial responsibility for health care (shared premiums). Patient…
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MACRAPerformance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
October 25, 2016

Your Wish List for MACRA Performance Improvement Technology

Even as CMS has eased the transition to MACRA with the Final Rule published on October 14, managing under Risk remains a core goal. The best way to prepare your organization? Develop MACRA Improvement Activities (formerly CPIAs), the training ground for managing under Risk. The MACRA Improvement Activities cover all of the processes and root causes of health care cost increases, and Medicare wants you to address them. Hint: they’re scoring your work. While the MACRA requirements are now superficially easy to meet—attest to at least one Performance Improvement Activity—the reality will be very different if you are really preparing for…
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
October 4, 2016

Improve Your Risk Readiness With Physician-Driven MACRA CPIA Innovation

CMS is pushing providers to accept Risk under Alternative Payment Models (APMs), and they’re sweetening the pot with incentives. But for the vast number of providers who will participate in MIPS because they don’t participate in risk-based APMs, the path to reward is murky. That’s because many Health Systems have a hard time visualizing how Performance Improvement with CPIAs can create savings under ACOs, the biggest APM model. Here’s the key: innovation that engages physicians. Historical Performance Improvement Often Leaves Out Physicians For most Health Systems, it’s rare for physicians to actively participate in Performance Improvement initiatives. There are two…
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Alternative Payment Models (APM)MACRAPerformance ImprovementValue-Based Health Care
September 20, 2016

MACRA APM Risk: 5 Keys for Redefining Performance Improvement

Whatever relief providers felt after the recent CMS MACRA Pick Your Pace announcement, don’t be fooled. CMS has not, it seems, backed off its goals of pushing providers toward Risk, nor the interim and final quotas for participation. To the contrary—the announcement pointedly suggested that providers consider joining a risk-based Alternative Payment Model (APM) in 2017. But here’s the bigger issue: most existing ACOs have failed to meet cost targets, and the risk of losses for risk-based APMs will fall back on the participating providers. MACRA Pick your Pace should not be a time of rest. You should run, not…
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Future of Health CareMACRAMeaningful UsePerformance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
September 13, 2016

CMS Okays MACRA Flexibility: Standstill or Startup for Providers?

With the CMS announcement last week that the final MACRA Rules will let providers pick and choose activities—or even delay requirements—2017 implementation is now a toss-up. Will providers double down on efforts to meet the MACRA standards in 2018? Or, will eased deadline pressure reverse momentum within health care systems? There are many valid reasons why the lead-time decision is important. MACRA represents one of the biggest overhauls of the Medicare reimbursement program, and many of the elements have not been fleshed out. Releasing final rules one month in advance of their going into effect surely makes it difficult for…
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry Reporting
August 23, 2016

ACO Under MACRA? Five Essential Takeaways

While Accountable Care Organizations (ACOs) get a little boost under proposed MACRA Rules, this comes at a price. MACRA provides a 5 percent bonus and a MIPS reporting exemption for providers who participate in an Advanced Alternative Payment Models, the most common being a Stage 2 or 3 ACO—if and only if they assume a minimum requirement for risk. The deal is this: CMS wants providers to move toward Alternative Payment Plans with greater financial risk by living under the equivalent of a budget for their patients’ health care. That concept, which imposes downstream risk to physicians if the budget…
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