Everything about health care is complicated—its rules, science, service delivery, organizational systems, financing, and the relationship between all participants. So too will be the solutions for measuring and managing its value as determined by quality, outcomes and cost. To imagine that we can simply change one part of health care and effect change throughout the […]
Create Value for Consumers by Leveraging ACO Provider Choice
Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking […]
Life, Liberty and Happiness Require Good Health: What Consumers Need to Get There
Independence Day reconnects us with our Founders’ values that “Life, Liberty, and the Pursuit of Happiness” are our fundamental rights. There is a basic concept underlying this dream: While the country will provide the opportunity, its citizens will act to achieve it. But there’s a catch—citizens’ potential to realize the dream depends on good health. […]
Tech Tools Empower Consumers to Reform Health Care: Will Providers Cooperate?
Health care is ripe for change, but providers have yet to take the lead. Who will push for much needed reform? Investors and technology experts are betting on consumers. Money is chasing health care technology (IT) startups to create consumer tools for everything from evaluating and comparing treatments and related costs, to managing medical conditions. […]
Why Patients Should Ask Questions—and Physicians Should Listen
For health care providers and payers, Value-Based Health Care (VBHC) is a hot topic, with most all payers pressing a shift toward financial risk contracts and ACOs based on quality and cost performance. But if you ask consumers about the trend, chances are you’ll get a blank stare. Why? They’re not really part of the […]
Tipping Point Test for ACOs: Consent to Financial Risk
Last week the conversation about financial risk for providers in ACOs took on a decidedly different and more contentious tone. After months of CMS reports of ACO growth and success, while retreating on MIPS quality reporting requirements as concessions to “provider burden,” CMS signaled that they were finished waiting for providers to accept financial risk […]
“Just the Facts, Ma’am”
Communication, according to Webster’s: “exchange of information” You and I talk all the time. We are constantly “communicating.” Communication is a huge idea that encompasses and displays our views of the world. But communication is more than just the sum of the words used to communicate; the words are contextual. Raymond Carver wrote with simple, […]
ACOs and Specialty Physicians: How Episodes of Care Create a Win-Win Cost and Quality Strategy
Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about […]
Unify ACO Quality and Cost Initiatives to Boost Long-term Results
Let’s face it. There’s a pretty low bar to meeting Medicare’s ACO Quality requirements. Most ACOs have achieved acceptable quality performance for Medicare Shared Savings Plans (MSSPs). They have not, however, achieved the savings needed to be successful. ACO supporters point to the “Triple Aim” of achieving higher quality, cost savings and good patient experience […]
ACO Economics 101: Optimize the Physician Network For Patient Choice
The inaugural MIPS 2017 submission period closed in a fog of uncertainty. The demise of MIPS looms on the horizon, with little discussion of opportunities for improvement. Heath and Human Services Secretary Azar has advocated for removing the quality reporting component of MIPS, while the Medicare Payment Advisory Committee (MedPAC) recommended scrapping MIPS altogether and pushed […]