Roji Intel Blog

Dave Halpert 0
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The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront, Roji Health Intelligence, Dave Halpert
ACOsCMS RulesData AggregationMIPS Value PathwaysValue-Based Health Care
November 9, 2023

The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront

The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although many policies were finalized as proposed, there are plenty of exceptions and caveats, and providers and practices need to be keenly aware of the details. CMS is using this rule to advance its value-based care goals through data aggregation and attention to health equity. Those…
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Theresa Hush 0
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ACOsEpisodes of CareSpecialty ServicesValue-Based Health Care
November 8, 2023

5 Tips for a Win-Win Collaboration Between ACOs and Specialists

As Value-Based Care expands, payers are emphasizing cost reduction all the more. Newer CMS payment models like ACO REACH reinforce cost control by capping reimbursement in total global payments to ACOs. In turn, global payments enable ACOs to directly negotiate rates with preferred provider specialists. In addition to focusing on controlling costs delivered through primary care, your ACO should pursue strategies to stem total patient care costs (TCC) through specialty services. Between 40 to 60 percent of total patient care costs are driven by specialty physicians. While rate negotiations address the price of individual specialty services, the greater opportunities lie…
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Theresa Hush 1
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Roji Health Intelligence Three Tips APP Reporting Approach ACOs Value-Based Care
ACOsAPP ReportingData AggregationValue-Based Health Care
August 11, 2023

Three Tips for Choosing Your APP Reporting Approach

If CMS’s new proposed option for APP Reporting becomes part of the Final Rule, ACOs will have the ability to limit quality reporting to Medicare patients only. Your ACO must now determine whether reporting Medicare-only patients saves work and money and best demonstrates your quality. Use these Roji TIPS to decide what approach will work for you. Considerations for Choosing Medicare CQMs versus All-Patient Reporting ACOs have resisted APP Reporting to avoid data aggregation from different physician EHRs. ACOs also want to limit their work to the core of Medicare patients included in the ACO. The following considerations are key…
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Theresa Hush 0
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Roji TIPS APP Reporting data aggregation ACOs
ACOsAPP ReportingData Best PracticesValue-Based Health Care
July 27, 2023

New for ACOs: Roji TIPS for Implementing APP Reporting

With the advent of APP Reporting, ACOs face a fundamental change in not only how they report quality measures, but also how they use data to drive results. That's true whether APP Reporting involves reporting quality for all patients or for Medicare-only patients via Medicare CQMs. Data is an asset that ACOs have never had. But data has the potential to influence all ACO functions and its success. Rather than depending on past admissions and ER utilization to retrospectively contact patients, ACOs that initially aggregate data will be able to use it to proactively identify patients who need more specific…
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Dave Halpert 0
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APM Performance PathwayAPP ReportingCMS RulesData Best PracticesMIPS Value PathwaysValue-Based Health Care
July 19, 2023

The 2024 CMS PFS Proposed Rule: 7 Attempts to Balance Participation Goals with Value

Reading between the many lines in the 1,920-page 2024 Medicare Physician Fee Schedule (PFS) Proposed Rule, one thing is clear: CMS is still struggling to move providers into Advanced Alternate Payment Models (APMs) and keep existing ACOs moving forward on the path to value-based payments. The APP Reporting tug-of-war between CMS and ACOs results in a slight concession for providers worried about difficulty and cost of all-patient APP Reporting. We’ve seen this before, of course. Remember the delay in sunsetting the Web Interface for ACOs in the 2022 Rule and the retreat from mandatory transition to risk in the 2023…
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Theresa Hush 1
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ACOsAPP ReportingData Best PracticesValue-Based Health Care
June 16, 2023

Don’t Fall for Magical Thinking in APP Reporting

Since the adoption of the 2023 Final Rule requiring ACOs to adopt Alternate Payment Model Performance Pathway (APP) quality reporting by performance year 2025, many ACOs have been scrambling to understand how to make the leap. There’s a huge difference between the old method of quality reporting using the CMS Interface to report on a 248-patient sample and the new requirement for APP reporting on all practice patients, regardless of payer type. The sheer size of reporting volume and mechanics means that your ACO will need to aggregate practice EHR data for the first time, even with fewer measures under…
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Theresa Hush 1
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ACOsArtificial IntelligenceFuture of Health CareValue-Based Health Care
May 18, 2023

How AI May Help – and Hurt – Your ACO

Artificial Intelligence (AI) advances are big news, but the daily onslaught of AI applications in health care is overwhelming. There’s no question that health care is fertile ground for AI. Health care is expensive, highly technical, complicated, and equally frustrating for patients and providers alike. It's also rich in data—a mostly untapped resource for both clinical and performance improvement. These factors make health care a perfect environment for AI, which can lead to potentially better and faster treatment for patients. And, there's lots of money in the system. Health care is also struggling with a worsening physician and staffing shortage.…
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Theresa Hush 1
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Roji Health Intelligence 3 Data-driven Approaches to Engage Specialists in ACOs Theresa Hush
ACOsData Best PracticesEpisodes of CareValue-Based Health Care
May 4, 2023

Three Data-Driven Approaches to Engage Specialists in ACOs

All ACOs, regardless of payment model, are built on a vision of primary care services to patients. Medicare attributes patients to your ACO based on the plurality of primary care services. CMS attributes a patient to a participating specialist only if the patient has not seen a primary care physician in the ACO or at other providers, and the specialist is providing “primary care” services to the patient. But the vision of the primary care ACO rarely holds up to reality—for either care delivery or economics. The shortage of primary care physicians, complicated by time constraints, often dictates that patients…
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Theresa Hush 0
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Supercharge Your ACO ROJI Health Intelligence Terry Hush
ACOsFuture of Health CareRiskValue-Based Health Care
April 20, 2023

Supercharge Your ACO to Compete Under Risk

Never has it been more important for ACOs to amp up Value with significantly higher cost savings and outcomes performance. More payment models are risk-based, changing economics for providers. Corporate health care and equity-backed practices are nabbing ACO physicians, making it hard for ACOs to sustain and grow. The next two years may be the last grace period for ACOs to show that provider-directed organizations can produce Value, before Medicare Advantage health plans—now chosen by half of beneficiaries—becomes the predominant model. That's why our spring 2023 eBook, Supercharge Your ACO: 6 Key Strategies for Top Value, is your essential guide…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Future of Health CareHealth EquityValue-Based Health Care
April 5, 2023

Jumpstart ACO Health Equity with Data-Based Collaborative Initiatives

Ever since the first pandemic data revealed the enormous cost of health inequities, the pressing question of how to rectify unfair access to quality health care has become a major policy discussion. Now the debate is turning to action, as the first Value-based Payment Model to address health equity comes online. ACO REACH is Medicare's response to blending several key values in its most advanced payment model to date. In addition to traditional ACO quality and cost values, ACO REACH also includes population-based payments (including global payments), rather than Fee-for-Service, and promotes health equity as a central goal. If your…
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