Summer is here, and the heat is on: barbeques, beaches, and the 2026 CMS Physician Fee Schedule Proposed Rule. Throughout 1,803 pages, CMS is going after the total cost of care in the MIPS and APM tracks of the Quality Payment Program (QPP). These proposed updates and the creation of a surprise new (and mandatory!) […]
Supercharge Your ACO to Compete Under Risk
Never has it been more important for ACOs to amp up Value with significantly higher cost savings and outcomes performance. More payment models are risk-based, changing economics for providers. Corporate health care and equity-backed practices are nabbing ACO physicians, making it hard for ACOs to sustain and grow. The next two years may be the […]
Promote ACO Success Under Value-Based Payment with These 5 Data Sources
ACOs have used “old school” data sources for many years to focus coordination of care activities. Perhaps your ACO has done the same, using reports such as admissions and ER discharges, post-acute admissions, visit history and missing labs to target patients for outreach. Similarly, your ACO might use HCCs to identify patients with higher risk […]
Your Smart Guide for APM Success
In the next several years, one of two things will happen: Either traditional health care providers will make the largest, make-or-break transformation of health care system economics and delivery of care in U.S. history, or the legacy health care system as we know it will not survive, but will be absorbed into the new corporate […]
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). […]
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 […]
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 […]
New ACO Playbook: Three Ultimate ACO Strategies to Keep Physician Practices Onboard
ACOs have zealously protected their favored status under Medicare Value-Based payment models, ensuring enough time for organizations to feel comfortable with financial risk and make investments in infrastructure. But if your own ACO is losing physicians to new equity-financed networks or to hospitals consolidating practices, more time does not help you. Primary care physicians are […]
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 […]
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 […]