Future of Health CareMerit-Based Incentive Payment System (MIPS)Quality Payment ProgramRiskValue-Based Health Care
November 7, 2018

The Final 2019 Quality Payment Program Rule: A Slow (but Steady) Push to Risk

Brew a pot of coffee! CMS has released a 2,378-page Final Rule covering the 2019 performance year for the Quality Payment Program, including the Merit-Based Incentive Payment System (MIPS). Those who dive into this document will gain insight into CMS’s vision for the future. It seems tortuous to suggest “reading between the lines” when there’s already so much laid out in black-and-white, but recognizing the context within the rule enables you to prepare for the future—spelled R-I-S-K. The Final Rule is very close to what was proposed back in July and has been similarly justified—CMS continues to cite Meaningful Measures, Patients…
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ACOsConsumers & PatientsPopulation HealthValue-Based Health Care
October 31, 2018

ACO Population Health Best Practices: More Respect for Physicians and Patients

How important is it to agree on principles and best practices for population health? More important than most providers believe, and here’s why: Population health can be a powerful engine for improving patient outcomes and cost performance in Value-Based Health Care. Failure to create a standard of population health practices means that every ACO or health system scrambles independently to create initiatives, without the benefit of broader experience and results. The outcome? ACOs make similar decisions or duplicate others’ programs with meager results. They may also inadvertently consign population health to safer territory as administrative instead of strategic and innovative…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
October 24, 2018

Consumers Want More Value from Value-Based Health Care: Why Providers Need to Listen

The dramatic rise in personal costs for health care services and coverage, sharpened by political battles over affordable care, is driving consumer health care activism to a new level. Voter projections indicate that health care will be the largest single voting issue in the 2018 mid-terms, with 30 percent of voters saying their decisions will depend on where Congressional candidates stand on health care coverage. While there may be a strong partisan split regarding the solution, broad dissatisfaction with the current system crosses party lines. Health care today takes a huge bite out of most Americans’ personal finances. It is now…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingResearchValue-Based Health Care
October 17, 2018

Wise Patients Really Can Make Medical Decisions

“The numbers in this blog are hard to believe. Why is the medical profession recommending shingles vaccine? It is one thing to say that patients should be their own advocates. But why would medical professionals recommend a vaccine to their patient that has such a paltry risk/benefit outcome? After all, we go to doctors because we presume that they know more about medical conditions, prevention and treatment than we do. If they don’t, what’s the point?” A wise patient reading my blog on the shingles vaccine made the above comments. The adjective “wise” has been defined as “able to make good judgments.”…
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
October 10, 2018

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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ACOsFuture of Health CareMedical Decision-MakingValue-Based Health Care
October 3, 2018

Why ACOs Must Build Trust with Providers and Patients to Meet Goals

As ACOs develop approaches to Value-Based Health Care, they are struggling with a key issue: lack of trust. How can providers commit to collective cost reductions that could have potentially negative revenue consequences for themselves individually or on their practices? If they don’t believe that the other players or their ACO are operating in the best interests of all involved, how can they participate in the ACO’s goals? Conversely, how can the ACO create effective leadership and collaboration if physicians are unwilling to commit to making the model succeed? Likewise, ACOs have to work harder to earn patients’ trust. Ask…
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ACOsBundled PaymentsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
September 26, 2018

Five Strategies for Specialists: How to Safely Navigate ACO Arrangements

Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also the most expensive for ACOs and health plans. That makes them a target for cost control. We have spoken about the need for ACOs to evaluate specialists carefully and ensure that specialists have input into ACO assessments of their cost and quality. Here we address specialists…
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ACOsFuture of Health CarePerformance ImprovementValue-Based Health Care
September 19, 2018

ACOs Under Risk: Select Specialists Based on Collaborative Audit Process

ACOs have tiptoed into developing a physician network based on value. Building a full lineup of primary and specialty physicians to serve their patient population presents a daunting challenge. Even more relevant, until downside financial risk arrangements become mandatory, ACOs have been able to keep their physician networks inclusive; managing cost of care has been a lower priority than maintaining volume of patients or physician relationships. All that is poised to change as ACOs come under downside financial risk. The threat of budgeted expense levels that mandate repayment to Medicare or forfeiture of revenues to health plans will change traditional…
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ACOsAlternative Payment Models (APM)Future of Health CareMedicareValue-Based Health Care
September 12, 2018

The ACO Challenge: Your Essential Reading List to Prepare for Risk

The concept behind Accountable Care Organizations remains reasonable: Groups of health care providers take responsibility for total cost and quality of care for the patients and receive, in return, a portion of any savings they achieve. But as CMS Administrator Seema Verma made clear in announcing the Proposed ACO Final Rule last month, “Medicare cannot afford to support programs with weak incentives that do not deliver value. ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up,…
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ACOsFuture of Health CareValue-Based Health Care
September 5, 2018

Ready or Not, Providers Will Face Risk Under ACOs or Medicare Advantage

In any other industry, companies work hard to interpret purchasing and regulatory trends, and adapt quickly in times of change. Swift action is a hallmark of competitive business; those that linger risk failure. Examples of business adaptation are everywhere: a move to digital applications that help consumers and other purchasers connect and build loyalty; acquisition or spin-off of business services to enhance growth; immediate response to negative press. But in health care, the pace of change at the industry’s core—healthcare organizations and health systems—is slow and barely responsive to the market. Case in point: while government and private health plans…
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