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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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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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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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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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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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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ACOsData Best PracticesRiskValue-Based Health Care
March 30, 2023

Promote ACO Success Under Value-Based Payment with These 5 Data Sources

ACOs have used "old school" data sources for many years to focus coordination of care activities. Perhaps your ACO has done the same, using reports such as admissions and ER discharges, post-acute admissions, visit history and missing labs to target patients for outreach. Similarly, your ACO might use HCCs to identify patients with higher risk factors for population health. Basic, easily found data like these sources provided a means for ACOs to launch valuable efforts in population health, when comprehensive claims and EHR data were not easily available. But as the pendulum swings toward financial Risk, your ACO needs to…
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ACOsAPP ReportingQuality Payment ProgramValue-Based Health Care
March 2, 2023

Amplify Your APP Payoff: Boost Quality and Costs with 3 Essential Data Types

Many ACOs are in the throes of planning to adopt APP Reporting. It’s a massive undertaking that can be costly, depending on your ACO's configuration of practices. If your ACO is scrambling to sort this out, you’re not alone in your abrupt initiation into the world of EHR data. Welcome to the joy ride. In our last post, we explained how to maximize the value of data aggregated for quality, as produced by either the HL7 and flat file method, or the QRDA method. Here we break down the data you need to achieve better quality in terms of patient…
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Roji Health Intelligence ACO Data APP Reporting
ACOsAPP ReportingValue-Based Health Care
February 2, 2023

Three Lies and a Truth About ACO Data for APP Reporting

If you're an ACO worried about APP Reporting, we get it. Your concerns about the feasibility and costs of aggregating data from multiple systems are completely valid. But don't let data complexity hoodwink you into a simplistic solution that will cost you more than the data is worth. Your solution to data aggregation needs to focus on "value," which means that your data aggregation should also garner the most return for your investment. If you are a one-EHR type of ACO, your data aggregation is relatively straightforward, and the cost will be reasonable. But you’re facing very different challenges if…
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ACO ReportingAPP ReportingCMS RulesValue-Based Health Care
January 5, 2023

Prepare Your ACO for APP Reporting with Our Ultimate Guide

No way out. That's the message of the CMS 2023 Final Payment Rule regarding APP quality reporting for ACOs. ACOs hoping for a reprieve to avoid all-patient quality reporting did not get it. APP Reporting will go forward by 2025, and ACOs must aggregate the patient data from provider systems to enable it. CMS has made it clear that accountable health care requires all-patient data to support both quality and equity in patient health care. You will need to act quickly. It takes experience, technology, and time to create the framework for a multi-practice database. You will need to become…
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