Roji Intel Blog

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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Dave Halpert 1
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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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Dave Halpert 0
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Roji Health Intelligence Alternate Payment Model Performance Pathway APP
Alternative Payment Models (APM)APM Performance PathwayClinical Data RegistryPerformance Improvement
November 16, 2022

No Worries About ACO APP! It’s Your Pathway to Improvement

With the release of the 2023 Physician Fee Schedule Final Rule, CMS upheld its commitment to sunset its Web Interface for ACO quality reporting after 2024. Beginning in 2025, ACOs will be required to report through the Alternate Payment Model Performance Pathway, or APP. Some have expressed concerns about the APP. But this new reporting process actually has some significant advantages. It presents ACOs with a valuable trove of data to advance along the path toward better outcomes, health equity, and curtailed costs. In fact, the baseline for APP—data from provider systems, including their EHR data—is the foundation for data…
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Theresa Hush 0
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Alternative Payment Models (APM)APM Performance PathwayEpisodes of CareValue-Based Health Care
October 31, 2022

Launch Time! Five Intervention Strategies to Fuel Your APM Liftoff

If you've followed the Smart Guide articles so far, your APM is ready for take-off. You’ve developed a data-sufficient technology infrastructure with both provider and claims data, carefully constructed your clinical network and engaged your clinicians, and implemented strategies for payers and consumers. Your APM may be operating already, with data ready to use. Now you are at the crossroads, and your choice will determine whether your APM will really transform outcomes for your patients and achieve maximum Value, or whether your APM will be average. That choice pivots on interventions. Only through specific interventions with clinicians and patients can…
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Theresa Hush 0
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Alternative Payment Models (APM)APM Performance PathwayConsumers & PatientsFuture of Health CareValue-Based Health Care
October 26, 2022

Need to Fire Up Your APM’s Consumer Strategies? Start Here

You've read it and you've experienced it: consumer frustration with an impersonal health care bureaucracy offering few conveniences, difficult navigation, high cost, and lack of transparency. Even as some organizations try to move forward with consumer-focused strategies, these are often still fledgling efforts with little overarching structure that fail to attract consumer attention. Beyond implementing an EMR patient portal, traditional providers have been slow to develop the consumer focus necessary to generate trust and loyalty. Meanwhile, consumers are welcoming an abundance of health apps and other resources that enable them to manage their health and, if sickness strikes, get quick…
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Theresa Hush 0
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Alternative Payment Models (APM)APM Performance PathwayEpisodes of CareMedical Decision-MakingValue-Based Health Care
October 19, 2022

3 Ways to Engage Physicians to Lead Transformation in Your APM

Doctors leaving medicine spells trouble for health care. And there’s real reason for concern. A few weeks ago, the Mayo Clinic released its most recent study on physician burnout, revealing the highest rate in the survey’s 10-year history. Sixty-three percent of responding physicians reported one or more characteristics of burnout, with many noting depersonalization, an inability to maintain a work-life balance, and career dissatisfaction. The Mayo story was significant enough to be picked up by The New York Times. This worrisome trend creates a real quandary for Value-Based Care and adoption of Alternative Payment Models (APMs), since their success or…
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Theresa Hush 0
3
Data-sufficiency-for-acos
ACOsAdvanced Alternative Payment ModelsAPM Performance PathwayRiskValue-Based Health Care
July 14, 2021

ACOs: Scale Up Data to Achieve APM Success

Last updated July 27, 2022 More data is required for ACOs, now that Alternative Payment Models have moved to high gear. In this article we’ll take the mystery out of how to realistically gauge your data needs and scale up data, so that your ACO can be successful. We'll show you how to identify the links between what you want to accomplish as an ACO or medical group in value-based payment models and those data requirements, and help you target your data efforts.  Data will drive your analytics, and analytics will fuel your interventions to produce better outcomes and cost…
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Dave Halpert 0
2
ACO ReportingACOsAPM Performance PathwayMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
June 2, 2021

The Real Registry Advantage for ACOs Reporting Via APP: 5 Myths Debunked

The clock is winding down on the CMS Web Interface, and the reality of mandatory quality reporting via the Alternate Payment Model Performance Pathway (APP) for ACOs in 2022 is setting in. In order for ACOs to develop and execute their APP quality reporting plan in time to avoid catastrophe, it’s imperative to begin evaluating options now. ACOs, however, have staged a push-back to the APP based on a number of assumptions about their impact on ACO economics, success in reporting, and elements of reporting. A lot of these are simply untrue, based on faulty assumptions about reporting through the…
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Theresa Hush 0
1
ACOsAPM Performance PathwayMerit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
May 24, 2021

New ACO Playbook: To Show Standout Performance, ACOs Must Rethink Quality

The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority of ACOs meet quality measures, with 92 percent passing the qualification for shared savings in 2019. But is quality performance a distinguishing feature that ACOs can use competitively—and sustain the payment model’s long-term prospects? To earn permanency and competitive advantage, ACOs must show that the…
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