Future of Health CareMedical EducationPerformance Improvement
December 19, 2018

There’s More to be Learned from Good Results than Bad—and Why It Matters

Becoming a physician requires passing many tests, beginning with premed studies, all the way through residency and, ultimately, board certification. You spend countless hours focused on passing examinations or rotations and learning to avoid pitfalls. As a residency program director, I and my colleagues invested considerable effort to determine which residents were struggling and to develop strategies to help them. We focused on finding deficiencies that would impede them from being excellent physicians. A fellow faculty member ran a Morbidity and Mortality conference that he nicknamed the “boo-boo” conference. This process of identifying and analyzing medical errors produced competitive physicians,…
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ACOsPopulation HealthValue-Based Health Care
November 14, 2018

How to Involve Physicians Effectively in ACO Population Health

In a recent post, we addressed the many types of population health initiatives and some guidelines for creating the most benefit. Now let’s take a closer look at one of those guidelines: integrating population health into regular or routine care of patients—specifically, with greater involvement and communication by the patients’ physicians. ACOs and their participating physicians have an opportunity to break with the historical obstacles between the physician’s employer organization and the physician, especially in hospital-directed ACOs. Even in physician-led ACOs, working seamlessly with physicians to achieve better health for ACO patients is key to achieving both quality and cost…
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ACOsFuture of Health CareMedical Decision-MakingValue-Based Health Care
October 3, 2018

Why ACOs Must Build Trust with Providers and Patients to Meet Goals

As ACOs develop approaches to Value-Based Health Care, they are struggling with a key issue: lack of trust. How can providers commit to collective cost reductions that could have potentially negative revenue consequences for themselves individually or on their practices? If they don’t believe that the other players or their ACO are operating in the best interests of all involved, how can they participate in the ACO’s goals? Conversely, how can the ACO create effective leadership and collaboration if physicians are unwilling to commit to making the model succeed? Likewise, ACOs have to work harder to earn patients’ trust. Ask…
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ACOsBundled PaymentsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
September 26, 2018

Five Strategies for Specialists: How to Safely Navigate ACO Arrangements

Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also the most expensive for ACOs and health plans. That makes them a target for cost control. We have spoken about the need for ACOs to evaluate specialists carefully and ensure that specialists have input into ACO assessments of their cost and quality. Here we address specialists…
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ACOsAlternative Payment Models (APM)Future of Health CareMedicareValue-Based Health Care
September 12, 2018

The ACO Challenge: Your Essential Reading List to Prepare for Risk

The concept behind Accountable Care Organizations remains reasonable: Groups of health care providers take responsibility for total cost and quality of care for the patients and receive, in return, a portion of any savings they achieve. But as CMS Administrator Seema Verma made clear in announcing the Proposed ACO Final Rule last month, “Medicare cannot afford to support programs with weak incentives that do not deliver value. ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up,…
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ACOsFuture of Health CareValue-Based Health Care
August 29, 2018

Time Out

It's the last week of August, the run-up to Labor Day, and time to re-energize as we head into a period that promises even more intense health care reform. We at Roji Health Intelligence wish you a relaxing end of summer and a chance to recharge before we're all back in the fall fray. For those of you who would like to use a little vacation time to catch up on some reading, here are links to content that will come in handy as CMS continues to ratchet up the pressure on ACOs to assume risk: Download our free eBook, How…
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Alternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
July 25, 2018

The Proposed 2019 Quality Payment Program (QPP) Rule: What You May Have Missed

Whoever said bureaucracy doesn’t foster change did not anticipate CMS’s Proposed Rule for the Quality Payment Program (QPP), 2019 performance year version, released on July 12. While the familiar overarching structure of MIPS remains, there are a number of revisions that activate newly developed policies. These include “Patients Over Paperwork” and “Meaningful Measures” efforts that CMS initiated in 2018 to streamline the requirements-heavy MIPS program. To be honest, there are some rough patches within the wrangling of old and new MIPS provisions in the 1,473 page 2019 Medicare Physician Schedule Proposed Rule, set to be published in the Federal Register…
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ACOsClinical Data RegistryMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
July 18, 2018

No More MIPS Cost Score Details? 5 Ways Providers Can Still Take Control of Costs

CMS is urging providers to participate in ACOs with downside risk, but they might be eliminating one of the keys that providers need to prepare. It couldn’t come at a worse time, when providers already stand to lose under risk-based models if they can’t identify where their cost issues lie. That data is only available from claims data made available by payers. Up until now, practices have had access to indispensable data on costs that are attributed to their providers, showing specifics of where they are above the norm. These were previously part of Quality and Resource Use Reports (QRURs)…
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ACOsAlternative Payment Models (APM)Consumers & PatientsMedical Decision-MakingValue-Based Health Care
June 6, 2018

Where’s the Value for Physicians in VBHC? Four Strategies for ACOs and Other APMs

When we talk about “value” in Value-Based Health Care (VBHC), we’re referring to the high-quality/lower-cost services that buyers want from health care providers. Who are the buyers? Health plans, Medicare and other governmental purchasers, plus employers (for the most part, the term is notably not interpreted to include patients). What do buyers want? “Truth in purchasing” for the best health care they can get. Indeed, the very term “Value-Based Health Care” implies that buyers are on a righteous quest for good care from irresponsible providers. Provider organizations, in turn, have sometimes adopted a similar attitude toward physicians. The generation of…
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ACOsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
May 9, 2018

ACOs and Specialty Physicians: How Episodes of Care Create a Win-Win Cost and Quality Strategy

Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about specialist-generated costs for most ACOs currently depends on the ACO’s structure. ACOs that are hospital-led or formed by multi-specialty health systems or networks may be less apt to look to specialty care for savings, except when the specialists are outside the ACO. Physician-led groups with…
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