February 9, 2022
Despite incredible work by health care workers during the pandemic, consumer and patient trust and belief in the health care system is dangerously low. Why is this a big problem now? Because as pressure to implement Value-Based Care initiatives is intensifying and creating more financial pressure on your already-slim margins, your health system or ACO must depend on patient-consumers to shore up your enterprise and revenues. Without building better consumer relationships, healthier consumers will seek alternatives and leave you with less revenues and sicker patients. In our previous post we delved into the reasons behind that breakdown in trust. Now…Read More
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…Read More
September 1, 2020
Video: The Right Data for Value-Based Success
Claims data isn't all you need to succeed under capitation. Here's why provider EHR clinical data should be added to identify variation in care and engage providers. 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.Read More
August 26, 2020
Straight Talk for Providers Adopting Capitation: Don’t Fly Blind Without the Right Data
Value-Based Reimbursement—once focused on incentives and shared savings—now more often means capitation. Whether adopting Medicare Alternative Payment Models (APMs) or contracting with health plans, physician groups and health systems have signaled greater willingness to adopt these new Risk payment models with their guaranteed payments for attributed patients. But here's the problem: If you don't have good data on your costs, you are flying blind. Let’s look at the myths and realities of what you really need both to measure your success under global capitation and to ensure that your Risk program is on track to be successful. Do You Need…Read More
August 12, 2020
How ACOs Can Control Costs with Physician Help, in 3 Steps. Really.
Health care has been drained emotionally and financially by the COVID-19 pandemic. Yet, in a surprising twist, that trauma has accelerated providers' willingness to adopt financial Risk. You may be one of many providers who have suddenly realized the value of predictable revenues like capitation. Receiving continual payments for attributed patients is appealing, especially when deferral of routine care has led many practices to the brink of failure. That’s why many providers are specifically considering capitation. For Groups with previous experience in managing risk pools, it's an easier decision. But if you represent an ACO that resisted CMS Rules to…Read More
June 26, 2020
The Fallacy of “Relief”: The Dangers of MIPS Extreme and Uncontrollable Circumstances Applications
Under the banner of “relief,” CMS has announced that clinicians will have the opportunity to file an Extreme and Uncontrollable Circumstances application to qualify for re-weighting in some or all components of the Merit-Based Incentive Payment System (MIPS). This possibility may sound intriguing, but don’t be fooled—those who take this route are overlooking the longer-term consequences of maintaining and expanding MIPS efforts. MIPS Is Not Going Away The day before releasing 2020 MIPS flexibility guidance, CMS announced the creation of the Office of Burden and Health Informatics, which has grown out of the Patients Over Paperwork initiative. In this notice…Read More
January 29, 2020
Can Artificial Intelligence and Machine Learning Reduce Health Care Costs?
All the experts’ 2020 health care technology predictions have one trend in common—more Artificial Intelligence. AI and its subset Machine Learning are tagged as the winning ticket to advances not only in clinical medicine and research, but also in administration and management. The hype promotes so many potential applications for AI that it begs for an answer to one of its key claims: Can AI reduce health care costs? I'm referring particularly to Artificial Intelligence that is beyond clinical medicine and new medical technology. AI focused on clinical medicine, from genomics to the latest radiology and cardiology diagnostic capabilities, uses…Read More
January 15, 2020
Can Consumers Be the Answer to Health Care Cost Control?
In the intense ramp-up to accepting Value-Based Health Care payment models that include financial risk, providers have implemented an array of technologies and programs to improve cost performance. They are in a race against time. Capitation is re-emerging as a dominant payment type under Medicare Value-Based Primary Care Models and commercial contracts. Alternative Payment Models demand payback for excess costs. In the crunch, however, the most important health care goal is getting lost: how to reduce long-term costs while improving patient outcomes. The most effective solutions will require more than just technology. They will require provider-consumer partnering, facilitated by consumer-focused…Read More
October 9, 2019
How Physicians Can Navigate to Get Better Value from Specialty Services
In recent articles, we’ve discussed how Value-Based Health Care must help consumers make good decisions. Equally as important, CMS is now emphasizing how physicians should serve as navigators for their patients, providing information and guidance. Let’s take a closer look at how the triad of primary care physician, specialist consultant, and patient can effectively engage in a process that improves Value through better outcomes and lower cost. To focus on the shifting role of primary care physicians (PCPs), we use “physician navigation” to describe PCP actions to coordinate care for their patients. To emphasize continuity of care at stake for…Read More
October 2, 2019
How Consumers Can Choose Quality in Value-Based Health Care
In our last article on how Quality should be reflected in Value-Based Health Care, we looked at the problematic route of quality measurement and reporting. The intent to develop payment for quality has resulted in a complex measurement system that produced provider-specific performance scores across hundreds of measures, yet has failed to advance achievement of better health care outcomes. The system creates flexibility for providers by allowing choice of measures, which eliminates consumers’ ability to see differences among providers. The quality agenda needs to mature. In its developmental period, there was a need to achieve consensus on the standard of…Read More