ACOsAPP ReportingData AggregationData Best PracticesFuture of Health CareValue-Based Health Care
June 27, 2024

Strategies for Right Now to Control Patient Care Costs

Policymaker confidence in Value-Based Care and the Accountable Care Organization (ACO) model has, so far, prevailed despite only small overall savings. There is still enduring belief that ACOs can rationalize health care and produce affordability by transformative strategies. But here’s where wishes and reality conflict: ACOs have, until now, lacked the data and tools to transform health care. The ACO savings results support the promise but not the delivery of affordable health care. The fact is that ACOs must deliver on the affordability of the promise, or as the shift to risk payment models continues, there will be financial consequences…
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Roji Health Intelligence Terry Hush ACOs Need a Strategic Map for Cost Control
ACOsData AggregationMedicareValue-Based Health Care
June 5, 2024

ACOs Need a Strategic Map for Cost Control

For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO PC Flex model, which is designed to create per-patient reimbursement for small ACOs in trade for higher reimbursements and funding for infrastructure. Most newer CMS payment models are now incorporating per-patient payments designed to lower the total cost of care. As the provider-driven vanguard in…
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Roji Health Intelligence 2024 Health Care Trends Theresa Hush
Artificial IntelligenceConsumers & PatientsCorporate Health CareData Best PracticesFuture of Health CareValue-Based Health Care
January 25, 2024

These Five Trends Are Steering Your Future Path to Value-Based Care

Buckle your seat belt. Health care is changing at warp speed. The Value-Based Care movement and leaps in technology and Artificial Intelligence are rapidly generating advances that will transform the health care environment. These factors will redefine health care providers and services, and how consumers access them. How you respond strategically will determine your survival as a health system, ACO, and health care provider. All of this rests on one essential fact: Value-Based Care in 2024 has graduated from a voluntary movement into certainty. There is arguably no one in health care who believes that there is an “out.” While…
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Roji’s customized APP Reporting Plan enables your ACO to meet highest quality Medicare APP reporting standards through our qualified registry, to meet Value-Based Care, while dramatically reducing reporting costs and creating actionable data.
ACOsAPP ReportingData AggregationValue-Based Health Care
January 11, 2024

Customized Roji APP Reporting Plan Cuts ACO Costs and Burden, Boosts ACO Capabilities

Start your APP Reporting of Medicare CQMs and save with Roji Health Intelligence’s customized APP Reporting Plan for ACOs. Our new service enables your ACO to meet the highest quality reporting standards through our qualified registry, while dramatically reducing reporting costs and creating actionable data for use in population health, equity, and cost performance. What’s at Stake for Large ACOs? The finalized Medicare PFS Rule released in November 2023 toppled a big barrier for 2024 ACO quality reporting. CMS provided an option to allow ACOs to report measures for Medicare patients only—and of most importance, created the avenue to identify…
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ACOsAPP ReportingCMS RulesMedicareValue-Based Health Care
December 12, 2023

How Your ACO Can Optimize APP Reporting Using Medicare CQMs

ACOs just gained a reprieve from implementing all-patient APP quality reporting in 2024. A provision in CMS’s Physician Fee Schedule Final Rule, which goes into effect on January 1, 2024, enables ACOs to report on Medicare patients only, based on CMS provision of eligible patient lists for three APP measures. If your ACO decides to delay aggregation of practice data for now, you need to consider how to optimize APP Reporting of Medicare CQMs. Choose a qualified registry for APP Reporting that can reduce your workload for reporting Medicare CQM Measures. Using CMS’s list of patients eligible for measures will…
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The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront, Roji Health Intelligence, Dave Halpert
ACOsCMS RulesData AggregationMIPS Value PathwaysValue-Based Health Care
November 9, 2023

The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront

The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although many policies were finalized as proposed, there are plenty of exceptions and caveats, and providers and practices need to be keenly aware of the details. CMS is using this rule to advance its value-based care goals through data aggregation and attention to health equity. Those…
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ACOsEpisodes of CareSpecialty ServicesValue-Based Health Care
November 8, 2023

5 Tips for a Win-Win Collaboration Between ACOs and Specialists

As Value-Based Care expands, payers are emphasizing cost reduction all the more. Newer CMS payment models like ACO REACH reinforce cost control by capping reimbursement in total global payments to ACOs. In turn, global payments enable ACOs to directly negotiate rates with preferred provider specialists. In addition to focusing on controlling costs delivered through primary care, your ACO should pursue strategies to stem total patient care costs (TCC) through specialty services. Between 40 to 60 percent of total patient care costs are driven by specialty physicians. While rate negotiations address the price of individual specialty services, the greater opportunities lie…
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Roji Health Intelligence Three Tips APP Reporting Approach ACOs Value-Based Care
ACOsAPP ReportingData AggregationValue-Based Health Care
August 11, 2023

Three Tips for Choosing Your APP Reporting Approach

If CMS’s new proposed option for APP Reporting becomes part of the Final Rule, ACOs will have the ability to limit quality reporting to Medicare patients only. Your ACO must now determine whether reporting Medicare-only patients saves work and money and best demonstrates your quality. Use these Roji TIPS to decide what approach will work for you. Considerations for Choosing Medicare CQMs versus All-Patient Reporting ACOs have resisted APP Reporting to avoid data aggregation from different physician EHRs. ACOs also want to limit their work to the core of Medicare patients included in the ACO. The following considerations are key…
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APM Performance PathwayAPP ReportingCMS RulesData Best PracticesMIPS Value PathwaysValue-Based Health Care
July 19, 2023

The 2024 CMS PFS Proposed Rule: 7 Attempts to Balance Participation Goals with Value

Reading between the many lines in the 1,920-page 2024 Medicare Physician Fee Schedule (PFS) Proposed Rule, one thing is clear: CMS is still struggling to move providers into Advanced Alternate Payment Models (APMs) and keep existing ACOs moving forward on the path to value-based payments. The APP Reporting tug-of-war between CMS and ACOs results in a slight concession for providers worried about difficulty and cost of all-patient APP Reporting. We’ve seen this before, of course. Remember the delay in sunsetting the Web Interface for ACOs in the 2022 Rule and the retreat from mandatory transition to risk in the 2023…
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ACOsArtificial IntelligenceFuture of Health CareValue-Based Health Care
May 18, 2023

How AI May Help – and Hurt – Your ACO

Artificial Intelligence (AI) advances are big news, but the daily onslaught of AI applications in health care is overwhelming. There’s no question that health care is fertile ground for AI. Health care is expensive, highly technical, complicated, and equally frustrating for patients and providers alike. It's also rich in data—a mostly untapped resource for both clinical and performance improvement. These factors make health care a perfect environment for AI, which can lead to potentially better and faster treatment for patients. And, there's lots of money in the system. Health care is also struggling with a worsening physician and staffing shortage.…
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