Roji Intel Blog

Dave Halpert 0
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ACOsAdvanced Alternative Payment ModelsAPP ReportingCMS RulesMerit-Based Incentive Payment System (MIPS)MIPS Value Pathways
July 16, 2024

CMS Presses for Accountable Care, Better Quality Measurement for Physicians and ACOs in New Proposed Rule

July brings us baseball, fireworks, and CMS’s Proposed Rules. In 2,248 pages of proposals, CMS has outlined its plans for MIPS, ACOs, and other Advanced Alternate Payment Models, and how they will transition from fee-for-service into a value-based care arrangement through the Quality Payment Program (QPP). We already know from the 2024 Final Rule that CMS plans to phase out Traditional MIPS in favor of MIPS Value Pathways (MVPs), and is committed to having all Traditional Medicare beneficiaries in an accountable care relationship by 2030. These Proposals continue to build on that framework, but it wouldn’t be a July ballgame…
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Theresa Hush 0
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ACOsAPP ReportingData AggregationData Best PracticesFuture of Health CareValue-Based Health Care
June 27, 2024

Strategies for Right Now to Control Patient Care Costs

Policymaker confidence in Value-Based Care and the Accountable Care Organization (ACO) model has, so far, prevailed despite only small overall savings. There is still enduring belief that ACOs can rationalize health care and produce affordability by transformative strategies. But here’s where wishes and reality conflict: ACOs have, until now, lacked the data and tools to transform health care. The ACO savings results support the promise but not the delivery of affordable health care. The fact is that ACOs must deliver on the affordability of the promise, or as the shift to risk payment models continues, there will be financial consequences…
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Theresa Hush 0
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Roji Health Intelligence Terry Hush ACOs Need a Strategic Map for Cost Control
ACOsData AggregationMedicareValue-Based Health Care
June 5, 2024

ACOs Need a Strategic Map for Cost Control

For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO PC Flex model, which is designed to create per-patient reimbursement for small ACOs in trade for higher reimbursements and funding for infrastructure. Most newer CMS payment models are now incorporating per-patient payments designed to lower the total cost of care. As the provider-driven vanguard in…
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Theresa Hush 0
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APP Reporting, APP Measures, health care cost savings
ACOsAPP ReportingData Best PracticesValue-Based Health Care
March 4, 2024

3 Ways Your ACO Can Convert APP Reporting Data into Higher Savings

Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That is a program vulnerability and one reason why value-based payments are increasingly incorporating population-based payment. Plainly stated, claims data (especially 2-5 months old) isn’t a great tool for identifying patient risks, Medicare HCCs notwithstanding. The timeline for cost prevention is before events occur, not when you’re looking…
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Theresa Hush 0
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Roji’s customized APP Reporting Plan enables your ACO to meet highest quality Medicare APP reporting standards through our qualified registry, to meet Value-Based Care, while dramatically reducing reporting costs and creating actionable data.
ACOsAPP ReportingData AggregationValue-Based Health Care
January 11, 2024

Customized Roji APP Reporting Plan Cuts ACO Costs and Burden, Boosts ACO Capabilities

Start your APP Reporting of Medicare CQMs and save with Roji Health Intelligence’s customized APP Reporting Plan for ACOs. Our new service enables your ACO to meet the highest quality reporting standards through our qualified registry, while dramatically reducing reporting costs and creating actionable data for use in population health, equity, and cost performance. What’s at Stake for Large ACOs? The finalized Medicare PFS Rule released in November 2023 toppled a big barrier for 2024 ACO quality reporting. CMS provided an option to allow ACOs to report measures for Medicare patients only—and of most importance, created the avenue to identify…
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Dave Halpert 0
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The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront, Roji Health Intelligence, Dave Halpert
ACOsCMS RulesData AggregationMIPS Value PathwaysValue-Based Health Care
November 9, 2023

The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront

The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although many policies were finalized as proposed, there are plenty of exceptions and caveats, and providers and practices need to be keenly aware of the details. CMS is using this rule to advance its value-based care goals through data aggregation and attention to health equity. Those…
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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
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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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