ACOsEpisodes of CarePopulation HealthValue-Based Health Care
October 20, 2021

New ACO Playbook: How to Supercharge Your ACO

Throughout the last decade of ACO development, many have struggled to identify what actually makes ACOs successful. Analyses have been fraught with conflicting conclusions. Studies have tagged type of ownership (hospital-based vs. physician-led), geographic region or urban-rural factors, primary-care-only versus specialty participation, ACO payment model type, patient volume, and operations strategies as links to success or failure. While such studies are often insightful and worth considering, they won’t pass scientific muster. That’s because ACO success does not depend solely on an ACO’s organizational attributes. Success in Your ACO Business Is Driven by Vision and Execution Like every business trying to…
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ACOsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 6, 2021

New ACO Playbook: Seven Keys to Expanding ACO Savings—and Market Share

At the beginning of this series, we laid out a basic tenet: As shared savings plan ACOs, you need to do as well or better at lowering costs than competing value-based payment models. Otherwise, your resources and support will dwindle in favor of more promising avenues to control Medicare spending, and competition will stifle your growth. We’ve examined the competition and what they offer physicians to succeed in Risk and to attract patients. The bar is high. Medicare Advantage Plans, equity-backed practices, and Management-model ACOs like Aledade have changed the playing field for physician participation and growth. ACOs Have Lost…
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ACOsSpecialty ServicesValue-Based Health Care
August 25, 2021

New ACO Playbook: 3 Strategies to Tackle Hidden Costs of Specialty Care

Your ACO’s most significant costs may seem obvious. CMS and most ACOs have put an enormous emphasis on reducing utilization of hospital facilities and nursing home care to control costs. But your real key to cost reduction is knowing what drives avoidable admissions and stays in the first place. And with 50-60 percent of costs attributed to specialty physicians, that is where you need to start. Specialists are—and should be—involved in your most complex patients’ care. Those specialists will benefit from a collaborative involvement in cost data. And both your ACO and your patients will benefit from better and more…
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ACOsFuture of Health CareRiskValue-Based Health Care
August 19, 2021

New ACO Playbook: Three Ultimate ACO Strategies to Keep Physician Practices Onboard

ACOs have zealously protected their favored status under Medicare Value-Based payment models, ensuring enough time for organizations to feel comfortable with financial risk and make investments in infrastructure. But if your own ACO is losing physicians to new equity-financed networks or to hospitals consolidating practices, more time does not help you. Primary care physicians are being picked off by your competition, and their patients go with them. Private equity firms and venture capital-funded groups have gained significant ground in acquiring physician practices, with mergers and acquisitions hitting record highs in 2019 and 2020, and accelerating in 2021. Equity firms and…
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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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ACOsEpisodes of CareFuture of Health CareRiskValue-Based Health Care
April 29, 2021

New ACO Playbook: Can Coordination of Care Save Enough Money to Save ACOs?

Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many others, however, dismiss the small proportion of savings—at a few percentage points—relative to total Medicare spending. The previous CMS administration was clearly dubious about the shared savings model. It favored payment models that put providers at financial risk to increase cost reduction incentives, even though…
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ACOsBehavioral HealthDirect ContractingRiskValue-Based Health Care
April 5, 2021

5 Value-Based Behavioral Health Strategies for ACOs and Medical Group Models

For ACOs and Direct Contracting Medical Groups adopting value-based payment models, behavioral health is often overlooked. But your patients’ unmet behavioral health issues are a big cost driver for emergency care and inpatient admissions, and they compound risk factors in disease. They also influence your patients’ adherence to treatment plans. You may believe this is a problem you can’t resolve because behavioral health is beyond the boundaries of your participating network. Even so, you need to be aware of a significant emerging trend: integrating behavioral health in primary care. The difference between physical medicine’s approach to disease versus behavioral health…
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ACOsEpisodes of CareRiskSpecialty Physicians
November 20, 2020

Five Strategies to Help ACOs and Independent Specialists Create Common Ground on Data Sharing

To successfully manage the 40 to 60 percent of costs of care driven by specialty physicians, your ACO must overcome one major obstacle when you begin to address specialty costs: the lack of information to guide your actions. Although ACOs have claims data to calculate total costs per ACO patient and totals for specialty services, you can't compare those costs. Why? Claims are not organized into cases or "episodes of care" that include all providers and services so that it is easier to compare case costs between patients or providers. More importantly, the small number of Medicare patients seeing any…
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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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ACOsBundled PaymentsEpisodes of CareRiskSpecialty ServicesValue-Based Health Care
October 22, 2020

Five Ways to Manage Specialty Costs Without Bundled Payments

When health plans and Medicare propose controlling the cost of specialty care, expect that bundled payments will be the next suggested solution. With the introduction of every new specialty-focused payment model, an episode-based bundled payment model is involved. But let's say you’re an ACO with no interest in bundled payments arrangements. You may not even think you can put the topic on the table with specialists. Or, if you are a health system or specialty practice that is trying to control total cost of care for competitive reasons, perhaps you aren't yet willing to accept fixed fees. How can you…
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