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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ACOsDirect ContractingFuture of Health CarePrimary Care PracticesValue-Based Health Care
March 18, 2021

With Competing Payment Models on Hold, What’s the Future for ACOs?

When CMS first announced new primary care payment models in April 2019, ACOs understood that their future might be threatened by competition for both physicians and patients. If medical groups could independently contract with Medicare under these models, they would have the advantage of greater control over their physician network, referral arrangements, and clinical decisions. The Value-Based primary care models of Direct Contracting (DC) and Primary Care First (PCF) were presented as a strategy to fortify primary care and independent practitioners. By combining prospective payment, quality monitoring, and incentive pools for lowering admissions and total costs, providers could potentially reap…
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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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ACOsMerit-Based Incentive Payment System (MIPS)Quality Payment ProgramValue-Based Health Care
December 2, 2020

The 2021 QPP Final Rule: A Warning Bell for ACOs and a Wake-Up Call for MIPS Participants

In a mere 2,165 pages, CMS has solidified the provisions of the 2021 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule. The Final Rule strongly resembles the Proposed Rule, and the implications, particularly for ACOs, are staggering. Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and the Alternate Payment Model (APP) Pathway The most substantial change is that 2021 will mark the introduction of the Alternate Payment Model (APM) Performance Pathway, known as the APP. The APP aligns MIPS and APM participation more effectively in the Quality Payment Program (QPP). The APP is a pre-defined set of…
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ACOsEpisodes of CareSpecialty ServicesValue-Based Health CareVideo
October 28, 2020

Video: How to Engage Specialists Through Centers of Excellence

Specialists will engage in cost performance improvement if they believe they can provide better care for their patients and improve their own clinical excellence. Here's how to achieve that through Episodes of Care, and how ACOs and health systems can help. You'll find more details in last week's post, Five Ways to Manage Specialty Costs Without Bundled Payments. 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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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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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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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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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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