Roji Intel Blog

Theresa Hush 0
92
Alternative Payment Models (APM)Future of Health CareValue-Based Health Care
May 18, 2022

Wanted: Better Script for Health System and Medical Group Transition to APMs

Health care has been suffering for a while—just ask any participant, including patients. You will hear about burnout, pressures to perform, changes in the market, pressures of new technology, fiefdoms, consumerism, and to top it off, the buildup of competition between traditional health care enterprises and new corporate health care businesses. Then there’s the pandemic, which may be sidelined publicly but continues to ravage health and the business of health care. Value-Based Care and its sidekick, Alternative Payment Models (APMs), continue to pressure health care finances. Providers, who have played cat-and-mouse with APMs for a while now, are beginning to…
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Evelyn Herwitz 0
259
Consumers & PatientsCost TransparencyFuture of Health Care
February 16, 2022

More Health Care Transparency Means Provider Conversations Need to Change

New federal laws and regulations focused on improving health care transparency are giving consumers significant access to essential health care information, particularly regarding costs. In a recent interview with Erika Grotto at HFMA, Roji CEO Terry Hush explains why that means the conversations that providers are having with their patients need to change. Listen to the podcast, and read the full transcript here. Read the blog post by Erika Grotto here. Founded in 2002, Roji Health Intelligence guides health care systems, providers and patients on the path to better health through Solutions that help providers improve their value and succeed in…
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Theresa Hush 0
92
ACOsConsumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
February 9, 2022

Seven Key Strategies for Health Systems and ACOs to Attract and Engage Consumers

Despite incredible work by health care workers during the pandemic, consumer and patient trust and belief in the health care system is dangerously low. Why is this a big problem now? Because as pressure to implement Value-Based Care initiatives is intensifying and creating more financial pressure on your already-slim margins, your health system or ACO must depend on patient-consumers to shore up your enterprise and revenues. Without building better consumer relationships, healthier consumers will seek alternatives and leave you with less revenues and sicker patients. In our previous post we delved into the reasons behind that breakdown in trust. Now…
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Theresa Hush 0
72
Consumers & PatientsFuture of Health CareValue-Based Health Care
January 24, 2022

Will Consumers Derail Your Value-Based Care Success?

Your health care organization may be on the tightrope of still coping with COVID-related illness and delivering essential patient care, amidst staffing and supply shortages. But in 2022, life is not poised to give health care a breather. Likewise, there is no slow-down to the expansion of Value-Based Care and payment models or development of further stages in 2022. This year, providers in traditional Medicare will rack up stiffer penalties if costs are higher than CMS algorithms calculate. More ACO providers will progress along the path to Risk, and more will participate in alternative payment models (APMs). This will be…
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Theresa Hush 0
24
ACOsAlternative Payment Models (APM)Future of Health CareRiskValue-Based Health Care
January 6, 2022

Five Predictions for the Fate of Value-Based Health Care in 2022

Only a few days into 2022, it seems obvious that many predicted “trends to watch” floated in late 2021 won’t, in fact, be what will matter most in this critical year for health care. Not that these issues aren’t important, but they are not new (if you’ve been paying attention and, hopefully, planning your strategies). The major predictions are underwhelming: Telemedicine and other types of virtual care will continue to advance. Digitization of health care for consumers will disrupt traditional channels of information and engagement. There will be more collaborations and blurred lines between payers and providers, and even more…
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Theresa Hush 0
208
ACOsFuture of Health CareRiskValue-Based Health Care
November 17, 2021

Supercharge Your Way to Value-Based Care

Whether you are an ACO, a health system considering value-based payment, or a medical group weighing your options for Value-Based Care, Roji’s new eBook, Supercharge your ACO for Top Value, has the strategies you need to reduce the cost of care and get clinician backing for innovation. The health care market’s reconfigured landscape puts ACOs—and health care organizations still in a Fee-for-Service contracting circuit—in danger of losing their ability to capture the savings from more effective and efficient health care driven by data, strong physician buy-in, and direct-to-consumer marketing. Medicare Advantage and equity-backed medical groups are competing with traditional providers…
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Dave Halpert 0
94
Merit-Based Incentive Payment System (MIPS)MIPS Value PathwaysQuality Payment ProgramValue-Based Health Care
November 10, 2021

The 2022 CMS PFS and QPP Final Rule: A Warning Shot to Provider Holdouts of Value-Based APMs

CMS has released the 2022 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule, and the message of these 2,414 pages is clear: CMS wants to push providers into value-based care arrangements. That intent was foreshadowed by the Proposed Rule released over the summer, which confirmed our predictions of trends under the Biden administration. Specifically, we saw a push to move providers into value-based care arrangements with an emphasis on closing the health equity gap, and a shift toward measuring progress through enhanced quality reporting requirements within a value-based care arrangement. To that end, in the Final Rule CMS…
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Theresa Hush 0
63
ACOsEpisodes of CarePopulation HealthValue-Based Health Care
October 20, 2021

New ACO Playbook: How to Supercharge Your ACO

Throughout the last decade of ACO development, many have struggled to identify what actually makes ACOs successful. Analyses have been fraught with conflicting conclusions. Studies have tagged type of ownership (hospital-based vs. physician-led), geographic region or urban-rural factors, primary-care-only versus specialty participation, ACO payment model type, patient volume, and operations strategies as links to success or failure. While such studies are often insightful and worth considering, they won’t pass scientific muster. That’s because ACO success does not depend solely on an ACO’s organizational attributes. Success in Your ACO Business Is Driven by Vision and Execution Like every business trying to…
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Theresa Hush 0
43
ACOsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 6, 2021

New ACO Playbook: Seven Keys to Expanding ACO Savings—and Market Share

At the beginning of this series, we laid out a basic tenet: As shared savings plan ACOs, you need to do as well or better at lowering costs than competing value-based payment models. Otherwise, your resources and support will dwindle in favor of more promising avenues to control Medicare spending, and competition will stifle your growth. We’ve examined the competition and what they offer physicians to succeed in Risk and to attract patients. The bar is high. Medicare Advantage Plans, equity-backed practices, and Management-model ACOs like Aledade have changed the playing field for physician participation and growth. ACOs Have Lost…
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Theresa Hush 0
19
ACOsSpecialty ServicesValue-Based Health Care
August 25, 2021

New ACO Playbook: 3 Strategies to Tackle Hidden Costs of Specialty Care

Your ACO’s most significant costs may seem obvious. CMS and most ACOs have put an enormous emphasis on reducing utilization of hospital facilities and nursing home care to control costs. But your real key to cost reduction is knowing what drives avoidable admissions and stays in the first place. And with 50-60 percent of costs attributed to specialty physicians, that is where you need to start. Specialists are—and should be—involved in your most complex patients’ care. Those specialists will benefit from a collaborative involvement in cost data. And both your ACO and your patients will benefit from better and more…
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