Roji Intel Blog

Theresa Hush 0
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ACOsCMS RulesCorporate Health CareEpisodes of CareFuture of Health CareValue-Based Health Care
December 13, 2022

5 Key Health Care Trends to Watch for in 2023

After an intense few years in health care, will 2023 deliver more punches? While 2022 was dubbed a COVID “recovery” year, as patient volume rebounded, health care staffing shortages festered. Burnout prompted physicians to retire, sell practices to corporate owners, or leave traditional health care for other employment. Simply put, 2022 was short on recovery and stability. Even still, 2022 fostered important new trends and discoveries. Despite inflation and recession fears, corporate health care continued its growth undaunted, with new startups and equity-backed practice expansion. Value-Based Care spurred corporate territorial reach into legacy health care preserves. Optum, ACO enablers like…
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Dave Halpert 0
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ACOsCMS RulesFuture of Health CareMIPS Value Pathways
November 7, 2022

2023 PFS Final Rule: 8 Key Strategies that Boost New ACOs and Increase Health Care Access

It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill the goals outlined in the Innovation Center’s Strategic Refresh of October 2021. Most notably, CMS has committed to having all Traditional Medicare beneficiaries in an accountable care program by 2030, and to prioritize health equity. To make this happen, CMS needs to shake up the…
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Dave Halpert 0
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ACOsAlternative Payment Models (APM)MIPS Value PathwaysValue-Based Health Care
July 12, 2022

CMS 2023 Proposed Rule Accelerates ACOs, MVPs

CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries' access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable care relationship by 2030, to ensure quality and total cost control. Its October 2021 Innovation Center’s Strategic Refresh identified issues with provider adoption of accountable care networks and alternative payment models (APMs). It also identified two objectives: to drive providers into Accountable Care Networks, and…
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Theresa Hush 0
208
ACOsFuture of Health CareRiskValue-Based Health Care
November 17, 2021

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 health care organizations still in a Fee-for-Service contracting circuit—in danger of losing their ability to capture the savings from more effective and efficient health care driven by data, strong physician buy-in, and direct-to-consumer marketing. Medicare Advantage and equity-backed medical groups are competing with traditional providers…
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Theresa Hush 0
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ACOsEpisodes of CarePopulation HealthValue-Based Health Care
October 20, 2021

New ACO Playbook: How to Supercharge Your ACO

Throughout the last decade of ACO development, many have struggled to identify what actually makes ACOs successful. Analyses have been fraught with conflicting conclusions. Studies have tagged type of ownership (hospital-based vs. physician-led), geographic region or urban-rural factors, primary-care-only versus specialty participation, ACO payment model type, patient volume, and operations strategies as links to success or failure. While such studies are often insightful and worth considering, they won’t pass scientific muster. That’s because ACO success does not depend solely on an ACO’s organizational attributes. Success in Your ACO Business Is Driven by Vision and Execution Like every business trying to…
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Theresa Hush 0
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ACOsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 6, 2021

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 growth. We’ve examined the competition and what they offer physicians to succeed in Risk and to attract patients. The bar is high. Medicare Advantage Plans, equity-backed practices, and Management-model ACOs like Aledade have changed the playing field for physician participation and growth. ACOs Have Lost…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
August 24, 2021

Cost Savings Aren’t the Only Objective for ACOs: Growth Matters, Too

Keeping within expenditure limits is a top priority for most ACOs for Medicare. That makes sense. Savings are the main distinguishing feature of an ACO arrangement, as opposed to straight Fee-for-Service reimbursement. ACOs that accept downside risk can’t afford to exceed the expenditure target. It’s in their best interest to create initiatives to cut costs and control expenses—especially for services outside the ACO, such as post-acute care. But a cost strategy only focused on trimming expenses will likely fail the ACO in the long run. Why? Medicare ACOs face an annually decreasing expenditure limit that mandates them to lower costs…
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Theresa Hush 0
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ACOsEpisodes of CareValue-Based Health Care
June 17, 2021

New ACO Playbook: How ACOs Can Transform Clinical Care for Diabetes

An illuminating article about ACOs, featuring current and former MedPAC chairs’ perspectives, argues that savings have been constrained because too much is beyond ACOs’ purview to manage. Examples include both external restrictions (the exclusion of prescription drugs and provider fee payments from ACO control) and internal cultural or economic barriers (conflicts of interest that make it difficult to reduce hospitalization revenues). ACOs Are Caught Between Roles as Provider and Payer The current ACO model is, indeed, challenging. Blending both provider and payer functions is fraught with conflict. But the provider-directed model was supposed to function closer to the actual delivery…
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Theresa Hush 0
1
ACOsAPM Performance PathwayMerit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
May 24, 2021

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 of ACOs meet quality measures, with 92 percent passing the qualification for shared savings in 2019. But is quality performance a distinguishing feature that ACOs can use competitively—and sustain the payment model’s long-term prospects? To earn permanency and competitive advantage, ACOs must show that the…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
May 13, 2021

New ACO Playbook: Three Touchstones for ACO Viability

Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force them into Risk. There are significant flaws to tying ACO structure to the viability or value of the model, however, or in discrediting ACOs which don’t yet produce those savings but may have other important characteristics for the long term. In a more competitive health…
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