Roji Intel Blog

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ACOsRiskValue-Based Health Care
April 14, 2021

Why ACOs Need a New Playbook

A lot has happened in health care since 2012, when final rules permitted provider-organized ACOs to be the driving force of Value-Based Care under the 2010 Affordable Care Act (ACA). As we pass the ACA’s eleventh anniversary, a dwindling number of Medicare Shared Savings Program (MSSP) ACOs are entering a new phase marked by higher expectations and more difficult economics. To succeed in this challenging environment, ACOs will need different tools going forward than first contemplated, because of competition, both from providers under new value-based payment models and from Medicare Advantage plans. They also face more skepticism. Although rule changes…
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ACOsBehavioral HealthDirect ContractingRiskValue-Based Health Care
April 5, 2021

5 Value-Based Behavioral Health Strategies for ACOs and Medical Group Models

For ACOs and Direct Contracting Medical Groups adopting value-based payment models, behavioral health is often overlooked. But your patients’ unmet behavioral health issues are a big cost driver for emergency care and inpatient admissions, and they compound risk factors in disease. They also influence your patients’ adherence to treatment plans. You may believe this is a problem you can’t resolve because behavioral health is beyond the boundaries of your participating network. Even so, you need to be aware of a significant emerging trend: integrating behavioral health in primary care. The difference between physical medicine’s approach to disease versus behavioral health…
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ACOsFuture of Health CareMerit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
December 9, 2020

7 New Value-Based Health Care Directions You’ll See in 2021

Everyone who's reeling from 2020 is hoping for light in 2021. Health care, especially—systems, hospitals, clinical practices and their providers—wants the pain to stop. What might lie ahead for health care next year? Here's what we're thinking about the near future, and what you should watch for in 2021. 1. Health care providers will be fortified. If one thing is clear from the election results, it's that relief is coming to help providers on the pandemic’s front line. Money won't be free-flowing, but it will be targeted to areas of financial distress. We should expect initiatives to centralize purchasing and…
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ACOsEpisodes of CareRiskSpecialty Physicians
November 20, 2020

Five Strategies to Help ACOs and Independent Specialists Create Common Ground on Data Sharing

To successfully manage the 40 to 60 percent of costs of care driven by specialty physicians, your ACO must overcome one major obstacle when you begin to address specialty costs: the lack of information to guide your actions. Although ACOs have claims data to calculate total costs per ACO patient and totals for specialty services, you can't compare those costs. Why? Claims are not organized into cases or "episodes of care" that include all providers and services so that it is easier to compare case costs between patients or providers. More importantly, the small number of Medicare patients seeing any…
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ACOsBundled PaymentsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 22, 2020

Five Ways to Manage Specialty Costs Without Bundled Payments

When health plans and Medicare propose controlling the cost of specialty care, expect that bundled payments will be the next suggested solution. With the introduction of every new specialty-focused payment model, an episode-based bundled payment model is involved. But let's say you’re an ACO with no interest in bundled payments arrangements. You may not even think you can put the topic on the table with specialists. Or, if you are a health system or specialty practice that is trying to control total cost of care for competitive reasons, perhaps you aren't yet willing to accept fixed fees. How can you…
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ACOsEpisodes of CareRiskSpecialty ServicesVideo
October 14, 2020

Video: How to Improve Specialty Spending for ACOs

Referral networks drive a huge part of ACO spending. Cut through the data to find how you can reduce costs through actionable information. Learn more about how your ACO should evaluate specialty referrals and costs using seven key analytics for procedural episodes of care. 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 Risk.
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ACOsEpisodes of CareRiskSpecialty Services
October 9, 2020

Seven Key Analytics to Direct Your ACO’s Specialty Strategies for Risk

As ACOs become subject to Risk arrangements, especially global capitation, specialty costs should be one of the first areas to examine for long-term savings potential. Optimal use of specialists and engagement with specialty providers will prove essential for cost management. This is new territory for providers who have decentralized most decisions about specialty referrals and subsequent specialty medical decisions. Leverage for collaboration and examination depends on the ACO’s strength position vis a vis specialty business and competition among specialists for ACO referrals. A primary ACO strategy for cost performance, therefore, must start with its market strategy. Your ACO Competition, Medicare…
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ACOsCost TransparencyRiskValue-Based Health CareVideo
October 1, 2020

Video: Cost Transparency Gives ACOs a Competitive Edge Under Risk

While your ACO isn’t subject to CMS's new rules about cost transparency, you’d be well advised to adopt this method to succeed under Risk through your own modified approach. As your organization establishes mutually beneficial relationships with providers, you can't avoid the choice to achieve savings by prioritizing strategies to focus on cost variations and areas of excess costs. To realize those goals, you’ll need to navigate the battleground of cost transparency by involving patients and physicians in discovery of costs. Learn more. Founded in 2002, Roji Health Intelligence guides health care systems, providers and patients on the path to…
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ACOsCost TransparencyMedical Decision-MakingRisk
September 23, 2020

ACOs, You Probably Think Cost Transparency Isn’t Your Problem. Think Again.

ACOs have largely sidestepped the cost transparency dispute raging between Medicare and medical providers, especially hospitals, due to CMS rules requiring providers to give consumers coverage-based cost estimates. If you're an ACO, you probably assume that cost transparency is not your problem. So you probably won't like to hear that your ACO should be helping your patients manage costs via cost transparency. Moreover, doing so will benefit you as much as your patients. Let's examine why this makes sense. Lack of Cost Transparency Disables Discussion of Value for Consumers Cost transparency really means giving advance price information to consumers so…
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ACOsEpisodes of CareRiskValue-Based Health CareVideo
September 16, 2020

Video: Create Effective Partnerships with Physicians for Value-Based Reimbursements

Physicians were trained to be scientific problem-solvers. Reach your potential under Risk by tapping into their overlooked talent to find the balance between best practice and costs. Learn Three Fixes for ACOs' Physician Engagement Strategies 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 Risk.
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