ACOsCMS RulesCorporate Health CareEpisodes of CareFuture of Health CareValue-Based Health Care
December 13, 2022

5 Key Health Care Trends to Watch for in 2023

After an intense few years in health care, will 2023 deliver more punches? While 2022 was dubbed a COVID “recovery” year, as patient volume rebounded, health care staffing shortages festered. Burnout prompted physicians to retire, sell practices to corporate owners, or leave traditional health care for other employment. Simply put, 2022 was short on recovery and stability. Even still, 2022 fostered important new trends and discoveries. Despite inflation and recession fears, corporate health care continued its growth undaunted, with new startups and equity-backed practice expansion. Value-Based Care spurred corporate territorial reach into legacy health care preserves. Optum, ACO enablers like…
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APM transition strategy, Terry Hush, Race to Value
ACOsAlternative Payment Models (APM)Value-Based Health Care
December 7, 2022

How to Define Your Transition Strategy to APM Success

Health care systems that have struggled to survive pandemic pressures won’t get a reprieve from competition any time soon. Since Covid shook the world, private investors in health care delivery have emerged as the most potent force driving change in delivering Value-Based Care. Equity-backed medical groups, ACO enablers with venture capital funding, and corporate health care have built their future around Alternative Payment Models (APMs) with population-based payments, which create a predictable revenue stream for their operations and investors, while drawing physicians and patients away from legacy systems. In this November 21, 2022 interview on Race to Value with Dr.…
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ACOsAPM Performance PathwayClinical Data RegistryValue-Based Health Care
November 30, 2022

Catapult Your Performance Using the APP and Achieve Data Sufficiency

In a previous post, we demystified the Alternate Payment Model Performance Pathway (APP) and explained how, by partnering with a Clinical Data Registry experienced in data aggregation and result submissions to CMS, you can avoid the bugaboos falsely attributed to APP reporting—perceived high costs and impossible timelines. Here we’ll show you how to leverage your new skills to elevate your ACO’s performance across the board, from quality scoring to effective patient management—and achieve data sufficiency, in the process. Achieve Better Scores and Insights from Quality Reporting Once your ACO’s data from all practices is aggregated, you will be ready to…
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ACOsCMS RulesFuture of Health CareMIPS Value Pathways
November 7, 2022

2023 PFS Final Rule: 8 Key Strategies that Boost New ACOs and Increase Health Care Access

It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill the goals outlined in the Innovation Center’s Strategic Refresh of October 2021. Most notably, CMS has committed to having all Traditional Medicare beneficiaries in an accountable care program by 2030, and to prioritize health equity. To make this happen, CMS needs to shake up the…
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ACOsAlternative Payment Models (APM)Future of Health CareValue-Based Health Care
October 5, 2022

Eight Key Strategies for APM Contracting Right Now

Are you considering entering into APM contracts with private payers? Bravo! Teaming with commercial health plans and employers is a strong opportunity for growing patients through APM arrangements. Expanding your APM agreements into all payment types will be essential to back the incentives you build into your workforce for performance-based pay. But those contracts must align with your APM strategies and support your goals. Our focus here is on APM contracts with health plans. Health plans may be eager to adopt these arrangements with you, if their analytics of your organization demonstrate good outcomes and reasonable costs. Population-based payments, which…
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ACOsFuture of Health CareRiskValue-Based Health Care
September 28, 2022

Just in Time for New Challenges: Updated “Supercharge Your ACO”

Our most popular eBook, Supercharge Your ACO for Top Value: A New ACO Strategy Playbook, just got better with new updates. Reflecting changes in the ACO model and environment over the year since publication, Roji Health Intelligence’s free eBook supports your journey to successful participation in Value-Based Care with the latest information and guidance. Here’s why that matters: The Accountable Care Organization model is dramatically changing. Just consider that the latest model with population-based payments, ACO Reach, is on the threshold to replace CMS's Direct Contracting and Next Generation APMs. This allows more risk-ready providers to adopt the ACO Reach…
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three-decisions-apm-adoption
ACOsAlternative Payment Models (APM)Future of Health CareNew Script for APMs
July 13, 2022

Three Key Decisions to Direct Your APM Adoption Strategy

How you ramp-up to full-scale APMs is crucial. Even if your multi-specialty group or health system receives some value-based payments with downside risk, your success hinges both on financial viability and retention of your clinicians and patients. If you delay APM adoption only after reviewing the potential on your bottom line, you’ll need to pay more attention to the competition that is lapping at your foundations of your provider network and consumers. Here are three key organizational decisions that will determine how your APM adoption proceeds: Should we own, enter into a joint venture, or participate in APM(s)? How much…
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ACOsAlternative Payment Models (APM)MIPS Value PathwaysValue-Based Health Care
July 12, 2022

CMS 2023 Proposed Rule Accelerates ACOs, MVPs

CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries' access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable care relationship by 2030, to ensure quality and total cost control. Its October 2021 Innovation Center’s Strategic Refresh identified issues with provider adoption of accountable care networks and alternative payment models (APMs). It also identified two objectives: to drive providers into Accountable Care Networks, and…
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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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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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