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, […]
Video: Specialists and Value-Based Reimbursements
With specialists driving a significantly large share of ACO costs, consider how to use episode-based inquiries in your ACO strategy. The higher the financial risk for ACOs, the more critical it is to incorporate specialty episodes and other features effectively. Read more here. Founded in 2002, Roji Health Intelligence guides health care systems, providers and […]
How Physicians Can Navigate to Get Better Value from Specialty Services
In recent articles, we’ve discussed how Value-Based Health Care must help consumers make good decisions. Equally as important, CMS is now emphasizing how physicians should serve as navigators for their patients, providing information and guidance. Let’s take a closer look at how the triad of primary care physician, specialist consultant, and patient can effectively engage […]
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 […]
Five Strategies for Specialists: How to Safely Navigate ACO Arrangements
Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also […]
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 […]