Roji Intel Blog

Theresa Hush 0
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ACOsEpisodes of CareRiskValue-Based Health Care
September 10, 2020

Three Fixes for ACOs’ Physician Engagement Strategies

ACOs know that reducing costs is the key goal for Value-Based reimbursement. But strategies on how—or even whether—to engage physicians in that goal have not always been successful, to the detriment of all involved. Part of the problem is that provider revenues still stem from Fee-for-Service payments. Physicians are still rewarded based on meeting volume of patients and revenues. Even if participating in an ACO, your physicians get very clear messages about meeting volume and revenue targets. Hospital and health system-based practices survive by ensuring that volume is maintained—especially in these times. As health plan capitation and new Value-based risk…
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Theresa Hush 0
0
ACOsEpisodes of CareRiskValue-Based Health Care
August 26, 2020

Straight Talk for Providers Adopting Capitation: Don’t Fly Blind Without the Right Data

Value-Based Reimbursement—once focused on incentives and shared savings—now more often means capitation. Whether adopting Medicare Alternative Payment Models (APMs) or contracting with health plans, physician groups and health systems have signaled greater willingness to adopt these new Risk payment models with their guaranteed payments for attributed patients. But here's the problem: If you don't have good data on your costs, you are flying blind. Let’s look at the myths and realities of what you really need both to measure your success under global capitation and to ensure that your Risk program is on track to be successful. Do You Need…
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Theresa Hush 0
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Episodes of CareFuture of Health CareRiskValue-Based Health Care
July 20, 2020

Episodes Are More Than Payment Models: They’re Key to Improving Care

For many health systems and groups, episodes are esoteric. Providers often think of them only in context of risk-based payment models like bundled payments and capitation. Navigating Value-Based Health Care contracts, providers analyze and model performance under Fee-for-Service and episode-based payments to decide their course of action. Or, if already in Value-Based reimbursement, they use them as targets for costs to pinpoint physicians who exceed the targets. These strategies are shortsighted and limited. Even at best, they do nothing to address what is actually driving cost of care. By using payer-constructed episode specifications, such strategies potentially obscure valuable clinical and…
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Dave Halpert 0
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COVID-19Merit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
June 26, 2020

The Fallacy of “Relief”: The Dangers of MIPS Extreme and Uncontrollable Circumstances Applications

Under the banner of “relief,” CMS has announced that clinicians will have the opportunity to file an Extreme and Uncontrollable Circumstances  application to qualify for re-weighting in some or all components of the Merit-Based Incentive Payment System (MIPS). This possibility may sound intriguing, but don’t be fooled—those who take this route are overlooking the longer-term consequences of maintaining and expanding MIPS efforts. MIPS Is Not Going Away The day before releasing 2020 MIPS flexibility guidance, CMS announced the creation of the Office of Burden and Health Informatics, which has grown out of the Patients Over Paperwork initiative. In this notice…
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Dave Halpert 0
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ACO ReportingCOVID-19RiskValue-Based Health Care
May 6, 2020

The Interim ACO Rule Explained: A Pause, Not a Reprieve

As the coronavirus pandemic continues to upend health care in the U.S., pressure has mounted on CMS to adjust its efforts to drive providers to adopt risk. In response, at the end of last week CMS announced a carve-out of COVID-19 patient expenses from certain reporting requirements. In this round, ACOs were on the receiving end, being largely excused from remaining 2019 reporting and 2020 enrollment obligations. True to our predictions, this will slow, but not reverse CMS’s ultimate agenda to push providers to manage under risk. Those who interpret the Interim Rule as a reprieve will do so at…
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Theresa Hush 0
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Future of Health CareRiskValue-Based Health Care
March 11, 2020

Value-Based Care Defined: Know the Vocabulary of Health Care Reform

Today, as we confront a viral threat that is challenging our health system, its capacity, and how care is financed, it seems appropriate to review some fundamentals. Health care reform has been speeding down a particular track, changing how health care is covered, paid, delivered, and organized. These reforms may seem to be about health care financing, but will make a future difference in health care access and patient outcomes. Medicare is driving the train with its huge budget and rulemaking capabilities. But insurance companies, in lockstep, are rapidly implementing similar changes. Understanding all those changes is no easy task.…
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Theresa Hush 0
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Artificial IntelligenceFuture of Health CareRiskValue-Based Health Care
January 29, 2020

Can Artificial Intelligence and Machine Learning Reduce Health Care Costs?

All the experts’ 2020 health care technology predictions have one trend in common—more Artificial Intelligence. AI and its subset Machine Learning are tagged as the winning ticket to advances not only in clinical medicine and research, but also in administration and management. The hype promotes so many potential applications for AI that it begs for an answer to one of its key claims: Can AI reduce health care costs? I'm referring particularly to Artificial Intelligence that is beyond clinical medicine and new medical technology. AI focused on clinical medicine, from genomics to the latest radiology and cardiology diagnostic capabilities, uses…
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Theresa Hush 0
1
Future of Health CareRiskValue-Based Health Care
January 22, 2020

Can Hospitals Still Lead Health Care Under Risk?

As the millennium's third decade begins, Risk has taken hold as THE strategy for tackling health care costs. Virtually overnight (in health care years) the industry has moved—albeit not uniformly—to accept Risk. This transition is already beginning to impact hospitals and hospital-based systems, and raises serious questions about the viability of their role as the primary financial engine bankrolling health care operations, reforms and modernization. Just one year ago, the concept of provider risk in Accountable Care Organizations (ACOs) was anathema to most participants. Despite initial misgivings, however, most ACOs remained in the system after CMS pushed forward with its…
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Theresa Hush 0
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Future of Health CareRiskSpecialty Physicians
August 7, 2019

Risk Payment Models Will Fuel Growth of Equity-Backed Physician Practices

Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses, although some have managed to achieve success solely by being excellent clinicians in their fields. Patients, however, are quick to see the flaws along with higher costs—hence complaints about customer service, poor billing practices, and difficulty communicating. But clinical practice success, up until now, has been measured by the yardstick of Fee-for-Service reimbursement: higher incomes through patient volume and services. Hospital purchasers of physician practices adopted the same benchmarks of success. Even as hospital…
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Dave Halpert 0
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Alternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Quality Payment ProgramRisk
July 31, 2019

A MIPS Rewrite is Certain: CMS Proposed Rule for the 2020 Quality Payment Program

The CMS Proposed Rule for the 2020 Physician Fee Schedule and changes to the Quality Payment Program picks up where the “Pathways to Success” ACO rule left off. This time, the “Pathways” shake-up is aimed squarely at MIPS, in the form of “MIPS Value Pathways.” We’ve described the growing frustration with MIPS, specifically MedPAC’s report to Congress on its concerns that MIPS is overly burdensome and complex, and doesn’t translate into better care. That theme repeatedly shines through the 1,704 page proposal. CMS is using this rule as an initial salvo indicating that MIPS as we know it is headed…
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