ACOsEpisodes of CareRiskValue-Based Health CareVideo
September 16, 2020

Video: Create Effective Partnerships with Physicians for Value-Based Reimbursements

Physicians were trained to be scientific problem-solvers. Reach your potential under Risk by tapping into their overlooked talent to find the balance between best practice and costs. Learn Three Fixes for ACOs' Physician Engagement Strategies here. 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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ACOsEpisodes of CareRiskValue-Based Health Care
September 10, 2020

Three Fixes for ACOs’ Physician Engagement Strategies

ACOs know that reducing costs is the key goal for Value-Based reimbursement. But strategies on how—or even whether—to engage physicians in that goal have not always been successful, to the detriment of all involved. Part of the problem is that provider revenues still stem from Fee-for-Service payments. Physicians are still rewarded based on meeting volume of patients and revenues. Even if participating in an ACO, your physicians get very clear messages about meeting volume and revenue targets. Hospital and health system-based practices survive by ensuring that volume is maintained—especially in these times. As health plan capitation and new Value-based risk…
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ACOsEpisodes of CareValue-Based Health CareVideo
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.
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ACOsEpisodes of CareRiskValue-Based Health Care
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…
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ACOsSpecialty PhysiciansValue-Based Health CareVideo
August 19, 2020

Video: Specialists and Value-Based Reimbursements

With specialists driving a significantly large share of ACO costs, consider how to use episode-based inquiries in your ACO strategy. The higher the financial risk for ACOs, the more critical it is to incorporate specialty episodes and other features effectively. Read more here. 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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ACOsEpisodes of CareValue-Based Health Care
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…
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Episodes of CareFuture of Health CareRiskValue-Based Health Care
July 20, 2020

Episodes Are More Than Payment Models: They’re Key to Improving Care

For many health systems and groups, episodes are esoteric. Providers often think of them only in context of risk-based payment models like bundled payments and capitation. Navigating Value-Based Health Care contracts, providers analyze and model performance under Fee-for-Service and episode-based payments to decide their course of action. Or, if already in Value-Based reimbursement, they use them as targets for costs to pinpoint physicians who exceed the targets. These strategies are shortsighted and limited. Even at best, they do nothing to address what is actually driving cost of care. By using payer-constructed episode specifications, such strategies potentially obscure valuable clinical and…
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Consumers & PatientsFuture of Health CarePrice Transparency
December 11, 2019

Can Consumers Ever Get the Transparency Needed to Predict Health Care Costs?

If you’re feeling squeezed to control your medical costs and pressured to find the essential information and help you need to do it, there's a good reason. Health care professionals, politicians, and economic experts are calling on consumers to make decisions about what services to get and where to get them. While Value-Based Health Care claims may focus on provider accountability for better and more coordinated, economic care, a secondary theme is to achieve greater accountability and cost sharing by patients. Giving consumers the tools to be accountable underlies the Transparency movement, including the new proposed rule from CMS that…
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ACOsConsumers & PatientsFuture of Health CareNarrow NetworksValue-Based Health Care
October 30, 2019

Is Patient Lock-In the Next Step in Value-Based Care?

Hoping to safeguard survival under financial risk, health care providers are courting a contentious issue: how patients select primary providers. During the HMO heyday , health care risk economics depended on patient selection of primary providers as part of coverage selection that “locked” them into those PCPs and their referral networks. PCPs operated as gatekeepers to the rest of the health care system, authorizing services (or not) for specialists and other care. It’s well known that the HMO’s Primary Care gatekeeper model generated a backlash among private sector consumers. In fact, the gatekeeper was so unpopular with patients that it…
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Future of Health CareMedical Decision-MakingPrimary Care PracticesValue-Based Health Care
June 26, 2019

Follow the Pathway to PCP Success In Medicare Direct Contracting

Primary care physicians were sitting on the sidelines as Medicare developed financial risk models in various generations of ACOs. At best, they could only hope to participate in Medicare Advantage and/or join a larger ACO. But potential for financial gain was elusive when the physicians’ success depended on the actions of others to achieve savings. Now Medicare is offering a carrot to large primary care practices with its new Direct Contracting (DC) models, luring them with the possibility of capturing higher and more predictable revenues as well as shared savings. CMS recently announced an initiative to test risk-based reimbursement models…
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