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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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 1
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ACOsAPP ReportingData Best PracticesValue-Based Health Care
June 16, 2023

Don’t Fall for Magical Thinking in APP Reporting

Since the adoption of the 2023 Final Rule requiring ACOs to adopt Alternate Payment Model Performance Pathway (APP) quality reporting by performance year 2025, many ACOs have been scrambling to understand how to make the leap. There’s a huge difference between the old method of quality reporting using the CMS Interface to report on a 248-patient sample and the new requirement for APP reporting on all practice patients, regardless of payer type. The sheer size of reporting volume and mechanics means that your ACO will need to aggregate practice EHR data for the first time, even with fewer measures under…
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