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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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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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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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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Roji Health Intelligence Alternate Payment Model Performance Pathway APP
Alternative Payment Models (APM)APM Performance PathwayClinical Data RegistryPerformance Improvement
November 16, 2022

No Worries About ACO APP! It’s Your Pathway to Improvement

With the release of the 2023 Physician Fee Schedule Final Rule, CMS upheld its commitment to sunset its Web Interface for ACO quality reporting after 2024. Beginning in 2025, ACOs will be required to report through the Alternate Payment Model Performance Pathway, or APP. Some have expressed concerns about the APP. But this new reporting process actually has some significant advantages. It presents ACOs with a valuable trove of data to advance along the path toward better outcomes, health equity, and curtailed costs. In fact, the baseline for APP—data from provider systems, including their EHR data—is the foundation for data…
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ACOsCMS RulesFuture of Health CareMIPS Value Pathways
November 7, 2022

2023 PFS Final Rule: 8 Key Strategies that Boost New ACOs and Increase Health Care Access

It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill the goals outlined in the Innovation Center’s Strategic Refresh of October 2021. Most notably, CMS has committed to having all Traditional Medicare beneficiaries in an accountable care program by 2030, and to prioritize health equity. To make this happen, CMS needs to shake up the…
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Alternative Payment Models (APM)APM Performance PathwayEpisodes of CareValue-Based Health Care
October 31, 2022

Launch Time! Five Intervention Strategies to Fuel Your APM Liftoff

If you've followed the Smart Guide articles so far, your APM is ready for take-off. You’ve developed a data-sufficient technology infrastructure with both provider and claims data, carefully constructed your clinical network and engaged your clinicians, and implemented strategies for payers and consumers. Your APM may be operating already, with data ready to use. Now you are at the crossroads, and your choice will determine whether your APM will really transform outcomes for your patients and achieve maximum Value, or whether your APM will be average. That choice pivots on interventions. Only through specific interventions with clinicians and patients can…
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Alternative Payment Models (APM)APM Performance PathwayConsumers & PatientsFuture of Health CareValue-Based Health Care
October 26, 2022

Need to Fire Up Your APM’s Consumer Strategies? Start Here

You've read it and you've experienced it: consumer frustration with an impersonal health care bureaucracy offering few conveniences, difficult navigation, high cost, and lack of transparency. Even as some organizations try to move forward with consumer-focused strategies, these are often still fledgling efforts with little overarching structure that fail to attract consumer attention. Beyond implementing an EMR patient portal, traditional providers have been slow to develop the consumer focus necessary to generate trust and loyalty. Meanwhile, consumers are welcoming an abundance of health apps and other resources that enable them to manage their health and, if sickness strikes, get quick…
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Alternative Payment Models (APM)APM Performance PathwayEpisodes of CareMedical Decision-MakingValue-Based Health Care
October 19, 2022

3 Ways to Engage Physicians to Lead Transformation in Your APM

Doctors leaving medicine spells trouble for health care. And there’s real reason for concern. A few weeks ago, the Mayo Clinic released its most recent study on physician burnout, revealing the highest rate in the survey’s 10-year history. Sixty-three percent of responding physicians reported one or more characteristics of burnout, with many noting depersonalization, an inability to maintain a work-life balance, and career dissatisfaction. The Mayo story was significant enough to be picked up by The New York Times. This worrisome trend creates a real quandary for Value-Based Care and adoption of Alternative Payment Models (APMs), since their success or…
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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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