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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Data-sufficiency-for-acos
ACOsAdvanced Alternative Payment ModelsAPM Performance PathwayRiskValue-Based Health Care
July 14, 2021

ACOs: Scale Up Data to Achieve APM Success

Last updated July 27, 2022 More data is required for ACOs, now that Alternative Payment Models have moved to high gear. In this article we’ll take the mystery out of how to realistically gauge your data needs and scale up data, so that your ACO can be successful. We'll show you how to 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 will drive your analytics, and analytics will fuel your interventions to produce better outcomes and cost…
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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 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 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 & PatientsCOVID-19Future of Health CarePopulation Health
June 11, 2020

Is Telehealth Bridging or Widening the Health Care Gap? We Need to Find Out.

ROJI Health Intelligence CEO Theresa Hush frames the questions we need to ask about the future of telehealth in this 3:37 minute video. Telehealth has become the go-to solution for health care during the COVID-19 pandemic, enabling providers and consumers to remain in contact for routine and non-emergency visits while brick-and-mortar spaces have been closed. Now that health care is reopening, however, telehealth remains a preferred communications medium, and many providers plan to expand it much more going forward. So, it’s time to ask: Are the services we are offering through telehealth really delivering the best health care possible? And,…
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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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Consumers & PatientsFuture of Health CareValue-Based Health Care
October 16, 2019

The Hedge Bet for Risk is Patient Experience

Creating a good Patient Experience in health care has gained little traction, despite being touted as one of the Triple Aim’s key goals in Value-Based Health Care. Health systems have been more focused on how to increase patients via health plan negotiations and consolidating regional providers, rather than focusing on the slower paced process of improving customer appeal. But now Patient Experience appears to be gaining some attention, and some forward-thinking providers are innovating to be more attractive to patients. Why? Because in the fiscal landscape of Risk, growing patient volume is essential. Providers are beginning to realize that there…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
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…
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