Roji Intel Blog

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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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ACOsEpisodes of CareRiskSpecialty ServicesVideo
October 14, 2020

Video: How to Improve Specialty Spending for ACOs

Referral networks drive a huge part of ACO spending. Cut through the data to find how you can reduce costs through actionable information. Learn more about how your ACO should evaluate specialty referrals and costs using seven key analytics for procedural episodes of care. 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 CareRiskSpecialty Services
October 9, 2020

Seven Key Analytics to Direct Your ACO’s Specialty Strategies for Risk

As ACOs become subject to Risk arrangements, especially global capitation, specialty costs should be one of the first areas to examine for long-term savings potential. Optimal use of specialists and engagement with specialty providers will prove essential for cost management. This is new territory for providers who have decentralized most decisions about specialty referrals and subsequent specialty medical decisions. Leverage for collaboration and examination depends on the ACO’s strength position vis a vis specialty business and competition among specialists for ACO referrals. A primary ACO strategy for cost performance, therefore, must start with its market strategy. Your ACO Competition, Medicare…
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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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