Roji Intel Blog

Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareMedical Decision-Making
July 11, 2018

Create Value for Consumers by Leveraging ACO Provider Choice

Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking services outside the ACO—for 60 percent of attributed total costs—providers argue that they can’t control total expenses, yet are on the hook for savings. They blame lack of coordinated care, duplicate tests and differences in the standard of care. Coordinated Patient Care Inside the Organization:…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
June 27, 2018

Tech Tools Empower Consumers to Reform Health Care: Will Providers Cooperate?

Health care is ripe for change, but providers have yet to take the lead. Who will push for much needed reform? Investors and technology experts are betting on consumers. Money is chasing health care technology (IT) startups to create consumer tools for everything from evaluating and comparing treatments and related costs, to managing medical conditions. The underlying assumption is that consumers will shop for good, affordable care. It’s the right time for health care IT to focus on consumers, who are feeling the pain of huge medical costs that were once paid by employers or government health plans. Either through…
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Dave Halpert 0
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ACOsAdvanced Alternative Payment ModelsAlternative Payment Models (APM)MedicareMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
June 13, 2018

Medicare Paths to Value-Based Health Care: Which Way is Up?

If you’re scratching your head about the direction of Value-Based Health Care (VBHC) in Medicare, you’re not alone. The current mix includes a swirl of separate initiatives, some new and others recently re-labled. As CMS pushes toward VBHC, providers may feel confused and frustrated as concepts emerge that will affect multiple programs. Within the last several months, the Patients Over Paperwork and Meaningful Measures initiatives have shaken up CMS value-based care programs, particularly: Merit-Based Incentive Payment System (MIPS) Medicare Shared Savings Program ACOs (MSSP ACOs) Direct Provider Contracting (DPC) Even more confounding, CMS is taking a non-linear development path for…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Consumers & PatientsMedical Decision-MakingValue-Based Health Care
June 6, 2018

Where’s the Value for Physicians in VBHC? Four Strategies for ACOs and Other APMs

When we talk about “value” in Value-Based Health Care (VBHC), we’re referring to the high-quality/lower-cost services that buyers want from health care providers. Who are the buyers? Health plans, Medicare and other governmental purchasers, plus employers (for the most part, the term is notably not interpreted to include patients). What do buyers want? “Truth in purchasing” for the best health care they can get. Indeed, the very term “Value-Based Health Care” implies that buyers are on a righteous quest for good care from irresponsible providers. Provider organizations, in turn, have sometimes adopted a similar attitude toward physicians. The generation of…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
May 30, 2018

Why Patients Should Ask Questions—and Physicians Should Listen

For health care providers and payers, Value-Based Health Care (VBHC) is a hot topic, with most all payers pressing a shift toward financial risk contracts and ACOs based on quality and cost performance. But if you ask consumers about the trend, chances are you’ll get a blank stare. Why? They’re not really part of the conversation. That’s a major problem, because consumer involvement is essential for VBHC success. When outcomes fall short, providers may complain about poor “patient compliance” with physician orders, and ACOs may bemoan lack of “patient engagement.” But they are minimizing patients’ preferences and concerns, or perhaps…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
May 23, 2018

Tipping Point Test for ACOs: Consent to Financial Risk

Last week the conversation about financial risk for providers in ACOs took on a decidedly different and more contentious tone. After months of CMS reports of ACO growth and success, while retreating on MIPS quality reporting requirements as concessions to “provider burden,” CMS signaled that they were finished waiting for providers to accept financial risk under Value-Based Health Care. With a third of Medicare patients served by an ACO and an even higher number of patients receiving health care via private sector ACOs, the industry seems on track to adopt ACOs as the preferred model of health care contracting and…
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Theresa Hush 0
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ACOsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
May 9, 2018

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 specialist-generated costs for most ACOs currently depends on the ACO’s structure. ACOs that are hospital-led or formed by multi-specialty health systems or networks may be less apt to look to specialty care for savings, except when the specialists are outside the ACO. Physician-led groups with…
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Theresa Hush 0
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ACOsConsumers & PatientsPerformance ImprovementValue-Based Health Care
April 25, 2018

Four ACO Development Decisions That Will Impact Return on Investment 

“It’s not how you start, but how you finish” might be the way some ACOs must navigate a difficult path to success.  But for organizations planning a new ACO venture, that rocky path may be avoidable. The early days of ACO development are behind us, and ACO models to take on financial risk are now underway. Achieving a return on ACO investment has proven to be elusive for most providers. There is progress, but no victory yet in sight. So ACOs and industry watchers are searching for the keys that allow some ACOs to experience more success than others. Whether…
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Dave Halpert 0
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
April 18, 2018

Unify ACO Quality and Cost Initiatives to Boost Long-term Results

Let’s face it. There’s a pretty low bar to meeting Medicare’s ACO Quality requirements. Most ACOs have achieved acceptable quality performance for Medicare Shared Savings Plans (MSSPs).  They have not, however, achieved the savings needed to be successful. ACO supporters point to the “Triple Aim” of achieving higher quality, cost savings and good patient experience through an ACO. To fulfill that tripartite goal, we must look past the hype and execute quality-cost initiatives that go well beyond CMS requirements. Recognize the Gap Between Quality Reporting Requirements and Quality Care Demonstrating quality and reducing costs are not mutually exclusive. While there…
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Thomas Dent, M.D. 0
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ACOsAdvanced Alternative Payment ModelsConsumers & PatientsMedical Decision-MakingValue-Based Health Care
April 11, 2018

ACOs Must Create Learning Environment for Physicians to Be Partners in Change

The idea behind ACOs sounds simple enough: Build a network of primary care physicians, specialists, hospitals and other health care organizations that share risk and responsibility to provide coordinated care for each patient. Medicare or private insurers offer financial incentives to ensure that ACOs provide quality treatment while limiting unnecessary spending. Primary care physicians serve as key liaisons for each patient’s care. But ACO reality is much more complex and daunting. Shared savings have proven to be elusive. Quality benchmarks do not always accurately measure what’s medically relevant. Patient attribution to specialists, rather than primary care physicians, skews costs. Nonetheless,…
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