Roji Intel Blog

Theresa Hush 0
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ACOsAlternative Payment Models (APM)Future of Health CareHealth EquityValue-Based Health Care
April 5, 2023

Jumpstart ACO Health Equity with Data-Based Collaborative Initiatives

Ever since the first pandemic data revealed the enormous cost of health inequities, the pressing question of how to rectify unfair access to quality health care has become a major policy discussion. Now the debate is turning to action, as the first Value-based Payment Model to address health equity comes online. ACO REACH is Medicare's response to blending several key values in its most advanced payment model to date. In addition to traditional ACO quality and cost values, ACO REACH also includes population-based payments (including global payments), rather than Fee-for-Service, and promotes health equity as a central goal. If your…
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Theresa Hush 1
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ACOsData Best PracticesRiskValue-Based Health Care
March 30, 2023

Promote ACO Success Under Value-Based Payment with These 5 Data Sources

ACOs have used "old school" data sources for many years to focus coordination of care activities. Perhaps your ACO has done the same, using reports such as admissions and ER discharges, post-acute admissions, visit history and missing labs to target patients for outreach. Similarly, your ACO might use HCCs to identify patients with higher risk factors for population health. Basic, easily found data like these sources provided a means for ACOs to launch valuable efforts in population health, when comprehensive claims and EHR data were not easily available. But as the pendulum swings toward financial Risk, your ACO needs to…
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Theresa Hush 0
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ACO ReportingAPP ReportingCMS RulesValue-Based Health Care
January 5, 2023

Prepare Your ACO for APP Reporting with Our Ultimate Guide

No way out. That's the message of the CMS 2023 Final Payment Rule regarding APP quality reporting for ACOs. ACOs hoping for a reprieve to avoid all-patient quality reporting did not get it. APP Reporting will go forward by 2025, and ACOs must aggregate the patient data from provider systems to enable it. CMS has made it clear that accountable health care requires all-patient data to support both quality and equity in patient health care. You will need to act quickly. It takes experience, technology, and time to create the framework for a multi-practice database. You will need to become…
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Theresa Hush 0
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ACOsCMS RulesCorporate Health CareEpisodes of CareFuture of Health CareValue-Based Health Care
December 13, 2022

5 Key Health Care Trends to Watch for in 2023

After an intense few years in health care, will 2023 deliver more punches? While 2022 was dubbed a COVID “recovery” year, as patient volume rebounded, health care staffing shortages festered. Burnout prompted physicians to retire, sell practices to corporate owners, or leave traditional health care for other employment. Simply put, 2022 was short on recovery and stability. Even still, 2022 fostered important new trends and discoveries. Despite inflation and recession fears, corporate health care continued its growth undaunted, with new startups and equity-backed practice expansion. Value-Based Care spurred corporate territorial reach into legacy health care preserves. Optum, ACO enablers like…
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Evelyn Herwitz 0
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APM transition strategy, Terry Hush, Race to Value
ACOsAlternative Payment Models (APM)Value-Based Health Care
December 7, 2022

How to Define Your Transition Strategy to APM Success

Health care systems that have struggled to survive pandemic pressures won’t get a reprieve from competition any time soon. Since Covid shook the world, private investors in health care delivery have emerged as the most potent force driving change in delivering Value-Based Care. Equity-backed medical groups, ACO enablers with venture capital funding, and corporate health care have built their future around Alternative Payment Models (APMs) with population-based payments, which create a predictable revenue stream for their operations and investors, while drawing physicians and patients away from legacy systems. In this November 21, 2022 interview on Race to Value with Dr.…
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Dave Halpert 1
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ACOsAPM Performance PathwayClinical Data RegistryValue-Based Health Care
November 30, 2022

Catapult Your Performance Using the APP and Achieve Data Sufficiency

In a previous post, we demystified the Alternate Payment Model Performance Pathway (APP) and explained how, by partnering with a Clinical Data Registry experienced in data aggregation and result submissions to CMS, you can avoid the bugaboos falsely attributed to APP reporting—perceived high costs and impossible timelines. Here we’ll show you how to leverage your new skills to elevate your ACO’s performance across the board, from quality scoring to effective patient management—and achieve data sufficiency, in the process. Achieve Better Scores and Insights from Quality Reporting Once your ACO’s data from all practices is aggregated, you will be ready to…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Future of Health CareValue-Based Health Care
October 5, 2022

Eight Key Strategies for APM Contracting Right Now

Are you considering entering into APM contracts with private payers? Bravo! Teaming with commercial health plans and employers is a strong opportunity for growing patients through APM arrangements. Expanding your APM agreements into all payment types will be essential to back the incentives you build into your workforce for performance-based pay. But those contracts must align with your APM strategies and support your goals. Our focus here is on APM contracts with health plans. Health plans may be eager to adopt these arrangements with you, if their analytics of your organization demonstrate good outcomes and reasonable costs. Population-based payments, which…
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Theresa Hush 0
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Smart Guide for APM Success, Terry Hush, Roji Health Intelligence
Alternative Payment Models (APM)Future of Health CareRiskValue-Based Health Care
August 11, 2022

Your Smart Guide for APM Success

In the next several years, one of two things will happen: Either traditional health care providers will make the largest, make-or-break transformation of health care system economics and delivery of care in U.S. history, or the legacy health care system as we know it will not survive, but will be absorbed into the new corporate business of health care. Successful APM adoption will make the difference. What is driving this transformation? Three forces are responsible: First, the urgent cost crisis in health care demands that providers become more accountable for costs and better patient care, and adopt value-based payment models…
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Theresa Hush 0
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5-imperatives-for-value-based-care-technology
Alternative Payment Models (APM)Episodes of CareFuture of Health CareNew Script for APMsPerson-centered Health CareValue-Based Health Care
June 23, 2022

5 Imperatives for Your Value-Based Technology to Support APMs

After years spent transforming your health care technology, you may feel like you're almost done. But Value-Based Care Technology requires a different mindset. With reimbursement scaling to a tipping point for APM adoption, think "reboot" instead. Your health system or group has a long way to go if your aggregated and integrated data cannot support person-centric care and data-directed population health, quality, and health equity strategies. The Value-Based Care Technology game is no longer focused on implementing an EHR, or even population health. Those are basic ingredients that make it possible to do more. Now it's about bringing all the…
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Theresa Hush 0
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Alternative Payment Models (APM)Consumers & PatientsFuture of Health CareNew Script for APMsValue-Based Health Care
June 8, 2022

Six Ways Competition Must Shape Your APM Strategy

Now that you've made the decision to start your path to Alternative Payment Models (APMs), what's the first thing you need to consider? Hint: APM revenue calculation does not top the list. Obviously, APM revenue generation vis-à-vis traditional Fee-for-Service is critical. But those calculations assume constancy of two essential “assets”—clinicians and patients. Your competition is working hard to grow these same resources for their own operations. The easiest place to get them from is your organization. If you are following the growth of practice acquisitions from investor-backed health care companies and MSOs, payer practice acquisitions and retail giant investments in…
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