Consumers & PatientsFuture of Health CareValue-Based Health Care
January 24, 2022

Will Consumers Derail Your Value-Based Care Success?

Your health care organization may be on the tightrope of still coping with COVID-related illness and delivering essential patient care, amidst staffing and supply shortages. But in 2022, life is not poised to give health care a breather. Likewise, there is no slow-down to the expansion of Value-Based Care and payment models or development of further stages in 2022. This year, providers in traditional Medicare will rack up stiffer penalties if costs are higher than CMS algorithms calculate. More ACO providers will progress along the path to Risk, and more will participate in alternative payment models (APMs). This will be…
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ACOsAlternative Payment Models (APM)Future of Health CareRiskValue-Based Health Care
January 6, 2022

Five Predictions for the Fate of Value-Based Health Care in 2022

Only a few days into 2022, it seems obvious that many predicted “trends to watch” floated in late 2021 won’t, in fact, be what will matter most in this critical year for health care. Not that these issues aren’t important, but they are not new (if you’ve been paying attention and, hopefully, planning your strategies). The major predictions are underwhelming: Telemedicine and other types of virtual care will continue to advance. Digitization of health care for consumers will disrupt traditional channels of information and engagement. There will be more collaborations and blurred lines between payers and providers, and even more…
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Merit-Based Incentive Payment System (MIPS)MIPS Value PathwaysQuality Payment ProgramValue-Based Health Care
November 10, 2021

The 2022 CMS PFS and QPP Final Rule: A Warning Shot to Provider Holdouts of Value-Based APMs

CMS has released the 2022 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule, and the message of these 2,414 pages is clear: CMS wants to push providers into value-based care arrangements. That intent was foreshadowed by the Proposed Rule released over the summer, which confirmed our predictions of trends under the Biden administration. Specifically, we saw a push to move providers into value-based care arrangements with an emphasis on closing the health equity gap, and a shift toward measuring progress through enhanced quality reporting requirements within a value-based care arrangement. To that end, in the Final Rule CMS…
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ACOsMerit-Based Incentive Payment System (MIPS)Quality Payment Program
July 19, 2021

The 2022 CMS PFS and QPP Proposed Rule: 7 Things to Know

After the 2020 election, we predicted seven trends to expect in Value-Based Care. Our forecasts were right on track. Last week the Biden Administration released its first Physician Fee Schedule and Quality Payment Program Proposed Rule, a 1,747-page document that promotes restructured value-based care initiatives. As we predicted, it recognizes both a significant health equity gap and a lack of useful data available to healthcare consumers as major challenges to overcome. We’re highlighting the seven biggest takeaways from the newly proposed Rule. Here’s the short version: The bar is higher, with substantial MIPS scoring changes ahead, and providers and organizations…
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ACOsRiskValue-Based Health Care
July 14, 2021

New ACO Playbook: 3 Approaches to Scale Up Data Sufficiency for Value-Based Care

Like every health care organization, your struggles with data may appear never-ending. Like money, there never seems to be enough of it. In this article we’ll take the mystery out of how to realistically gauge your data needs, identify the links between what you want to accomplish as an ACO or medical group in value-based payment models and those data requirements, and help you target your data efforts. Data Needs Have Scaled Up with Value-Based Care When providers were focused on meeting patient volume targets, operations systems like billing and scheduling provided an adequate basis for tracking volume and revenues.…
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ACO ReportingACOsAPM Performance PathwayMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
June 2, 2021

The Real Registry Advantage for ACOs Reporting Via APP: 5 Myths Debunked

The clock is winding down on the CMS Web Interface, and the reality of mandatory quality reporting via the Alternate Payment Model Performance Pathway (APP) for ACOs in 2022 is setting in. In order for ACOs to develop and execute their APP quality reporting plan in time to avoid catastrophe, it’s imperative to begin evaluating options now. ACOs, however, have staged a push-back to the APP based on a number of assumptions about their impact on ACO economics, success in reporting, and elements of reporting. A lot of these are simply untrue, based on faulty assumptions about reporting through the…
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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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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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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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