Roji Intel Blog

Theresa Hush 0
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ACOsCOVID-19Future of Health CareValue-Based Health Care
April 15, 2020

Stretched to the Limit by COVID-19, Will Providers Get Relief from Medicare Value-Based Programs?

This article originally appeared in the April 2020 edition of Accountable Care News . COVID-19 continues its inexorable, exponential spread here in the U.S. Hospitals in New York City, now accounting for more than 7 percent of confirmed cases worldwide, have less than a quarter of the critical equipment and supplies needed to serve an overwhelming surge of patients. Our health care providers are facing impossible choices, even considering universal Do Not Resuscitate orders for patients with COVID-19. Less than one month ago, CMS was closing applications from providers willing to be part of a major movement to adopt financial…
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Thomas Dent, M.D. 0
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Artificial IntelligenceFuture of Health CarePopulation HealthValue-Based Health Care
February 5, 2020

How AI Can Engage Consumers to Reduce Disease Risk: The Case of Atrial Fibrillation

In our last article, we assessed how AI could be used to achieve clinical success for individual conditions, and to apply the technology to broad cost reduction efforts and population health interventions. But here's the real test: Can we effectively apply AI technology to help patients better engage in lifestyle risk reduction—particularly for specific conditions at higher risk? To examine the feasibility and issues, let’s take a closer look at Atrial Fibrillation (AFib), an increasingly common and expensive condition. In AFib, the upper part of the heart (the atrium) has ineffectual contraction, causing sludging of the blood and lessened cardiac…
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Theresa Hush 0
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Future of Health CareRiskSpecialty Physicians
August 7, 2019

Risk Payment Models Will Fuel Growth of Equity-Backed Physician Practices

Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses, although some have managed to achieve success solely by being excellent clinicians in their fields. Patients, however, are quick to see the flaws along with higher costs—hence complaints about customer service, poor billing practices, and difficulty communicating. But clinical practice success, up until now, has been measured by the yardstick of Fee-for-Service reimbursement: higher incomes through patient volume and services. Hospital purchasers of physician practices adopted the same benchmarks of success. Even as hospital…
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Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesValue-Based Health Care
July 24, 2019

Can ACOs Survive the Complicated New Landscape in Medicare Risk?

What a difference a year makes. In Spring 2018, many Accountable Care Organizations (ACOs) pondered a walkout over Medicare plans that included downside risk in ACO financials. Nonetheless, CMS finalized its plans to make provider risk a reality for all ACOs in its Pathways to Success overhaul of the Medicare Shared Savings Program (MSSP). ACOs’ lukewarm reception to the goal of compelled savings, however, was not forgotten. Fast forward to April 2019, when CMS announced five Primary Care Models to propel physician groups to adopt risk-based reimbursement directly—including capitation. Those models are now under fast-paced implementation, with application deadlines approaching.…
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Theresa Hush 0
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ACOsBundled PaymentsFuture of Health CareRiskValue-Based Health Care
May 22, 2019

Can Provider Risk Cure High Medical Costs?

Fee-for-Service (FFS) has been on a slow march toward risk-based reimbursement for two decades. But FFS has proven to be remarkably resilient—until now. In the last six months, Medicare has doubled down on creating new provider risk models for ACOs, specialists and primary care physicians. All of them have methods to ensure that providers are held accountable for medical expenditure targets. Wait. Haven’t we been here before? What‘s different between now and the 1980s, when HMOs and provider risk first prevailed in the market—and then were purged as both ineffective and unpopular? Is provider risk a cure for high medical…
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Theresa Hush 0
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Population HealthRiskValue-Based Health CareWomen and Health Care
February 6, 2019

Higher Risks, Worse Disease, Fewer Choices: Health Care Fails African American Women the Most

No matter how we measure disparity in health care for women in the U.S, African American women stand out. Across the board, they have higher risk factors for disease and poorer outcomes, including much higher mortality for many conditions. African American women contract cardiac disease and cancer at a younger age and, often, in worse forms. Their risk of maternal death after giving birth is three or four times greater. Health care for African American women is complicated by racial and gender prejudices as well as by poverty and inadequate insurance coverage. But even among African American women who are…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CarePopulation HealthValue-Based Health Care
December 5, 2018

Should Value-Based Health Care Help Improve Life Expectancy?

As Americans in a highly developed and prosperous economy, we have ascribed a value to our highly sophisticated, expensive health care system—that it should enable us to achieve better health. If we didn’t believe in the value of our health care system, we would not support health coverage, most people would not visit health care providers, and the public health system would not get be funded. This may sound all too obvious, but it isn’t. Whether our health care system actually achieves that ascribed value of improving health status is now in question. Given last week’s release of Center for…
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Dave Halpert 0
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MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
November 8, 2016

Risky Business: How to Make Risk Adjustment Fair and Accurate for Quality Measurement

No two patients are the same. Some are much sicker than others. Obvious? Yes. But this is the fundamental challenge of quality measurement. As public scrutiny of physician performance intensifies via the CMS Physician Compare website, and as outcome comparisons become ever more crucial to Medicare and private insurance reimbursement strategies, finding a fair and accurate way to adjust for risk is critical. Each patient population has its own challenges. Academic medical centers may get the most difficult cases, but solo practitioners see the entire community, and without the infrastructure available elsewhere. For health care to improve for all patients,…
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