ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
October 10, 2018

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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ACOsBundled PaymentsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
September 26, 2018

Five Strategies for Specialists: How to Safely Navigate ACO Arrangements

Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also the most expensive for ACOs and health plans. That makes them a target for cost control. We have spoken about the need for ACOs to evaluate specialists carefully and ensure that specialists have input into ACO assessments of their cost and quality. Here we address specialists…
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ACOsAlternative Payment Models (APM)Future of Health CareMedicareValue-Based Health Care
September 12, 2018

The ACO Challenge: Your Essential Reading List to Prepare for Risk

The concept behind Accountable Care Organizations remains reasonable: Groups of health care providers take responsibility for total cost and quality of care for the patients and receive, in return, a portion of any savings they achieve. But as CMS Administrator Seema Verma made clear in announcing the Proposed ACO Final Rule last month, “Medicare cannot afford to support programs with weak incentives that do not deliver value. ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up,…
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Bundled PaymentsFuture of Health CareValue-Based Health Care
August 1, 2018

Five Steps for Successful Initiation of Bundled Payments and Episodes of Care

Everything about health care is complicated—its rules, science, service delivery, organizational systems, financing, and the relationship between all participants. So too will be the solutions for measuring and managing its value as determined by quality, outcomes and cost. To imagine that we can simply change one part of health care and effect change throughout the entire system is naïve, even ridiculous. Nonetheless, a recent analysis of how bundled payments failed to lower costs is being used as an example of why such reimbursements aren’t effective in changing incentives for high medical costs. While the analytical results show little difference in…
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Alternative Payment Models (APM)Bundled PaymentsFuture of Health CarePerformance ImprovementValue-Based Health Care
January 24, 2018

BPCI Advanced Means Financial Risk Is Coming for Specialists

In case you missed Medicare’s messages about its reimbursement direction in recent years, CMS just reminded us that financial risk is well on its way. If you’re developing strategies that assume the status quo, it’s time to reassess your organization’s financial footing. CMS has already stated its intention to shift 50 percent of Medicare provider reimbursement into Alternative Payment Models (APMs) by the end of this calendar year. And those APMs are quickly transitioning toward putting providers at financial risk, because CMS is rewarding them to do so. CMS’s goal to impose financial risk was front and center again this…
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
August 23, 2017

CMS Eliminates Episode Groups in MIPS Cost Tracking for 2018—But Providers Should Not

It’s no surprise that Cost is one of the most significant targets of Medicare Value-Based Health Care initiatives, as well as those in the private sector. So it was a real surprise last month to learn that CMS would delay weighing Cost as a component of MACRA MIPS total scoring. Equally significant is the CMS plan to scrap the ten episodic cost measures that were part of the cost calculation for provider groups in exchange for new, “to be determined” versions. Does this retreat from Cost and episodic costs calculation signal a big shift in the direction of Medicare Value-Based…
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MACRAPerformance ImprovementQualified Clinical Data Registry Reporting
May 31, 2017

How to Improve Patient Outcomes with a Multi-Specialty QCDR

Care coordination and HIT interoperability are touted throughout the healthcare world as “must haves” for any provider, practice or health system. The reason is simple: information from multiple sources helps providers and patients to make informed clinical decisions and provide better care. A key pillar in any program that quantifies whether providers are “meaningfully using” their EHRs is the ability to send and receive information on a specific patient. If that’s true at the point of care, doesn’t it make sense that performance measurement and improvement would benefit from the same treatment? Qualified Clinical Data Registries (QCDRs) were created specifically…
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient Empowerment
April 12, 2017

Why MACRA MIPS Cost Episodes Make Good Products for Health Care Consumers

Here’s a radical idea: What if providers re-envisioned MIPS as a patient marketing initiative, not a regulatory response? Yes, I’m serious. From the beginning of PQRS and Meaningful Use to MACRA, health systems considered these efforts to be merely “compliance” with regulations and not market initiatives. But this view is shortsighted. As outlined in MACRA rules, all of the MIPS initiatives parallel changes that consumers, employers and health plans have been demanding: lower costs, quality, improvement and value. Analyzing the MIPS component of Cost provides a good way to evaluate how providers could use Medicare data to help remap their…
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Future of Health CareMACRAPatient EmpowermentPerformance ImprovementValue-Based Health Care
March 29, 2017

Why Bundled Payments Are a Win-Win for Specialists and Health Care Consumers

Bundled payments, a health care payment innovation that has been widely praised for controlling costs, recently got a bad rap. Secretary of Health and Human Services Tom Price  has delayed implementation of the final Medicare rule for several bundled payment programs that were set to start this year. He has criticized the bundled payments initiative for moving too fast and “experimenting with patients’ health.” Other industry experts disagree. They strongly favor the concept for both improving care and cutting costs. Bundled payments reimburse physicians and hospitals according to a set fee that includes all care associated with a procedure or…
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ACO ReportingAlternative Payment Models (APM)Future of Health CareMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 7, 2016

Proposed MACRA Rules: Your APM Strategy for Risk Readiness

If you chose not to participate in Medicare ACOs or Bundled Payments in recent years, CMS is planning to change your mind. Proposed MACRA Rules reveal a complex carrot-and-stick approach to inducing providers into risk models. Make no mistake: it’s just a matter of when, not if, you participate in one of the Alternative Payment Models (APMs). It will pay (literally) to begin planning your path to risk now. Here are five important provisions in the Proposed Rules that you need to understand: Full qualification as an Advanced APM earns a 5 percent lump sum bonus, exemption from participation in…
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