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 […]
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 […]
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 […]
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 […]
Three Data-Driven Approaches to Engage Specialists in ACOs
All ACOs, regardless of payment model, are built on a vision of primary care services to patients. Medicare attributes patients to your ACO based on the plurality of primary care services. CMS attributes a patient to a participating specialist only if the patient has not seen a primary care physician in the ACO or at […]
Supercharge Your ACO to Compete Under Risk
Never has it been more important for ACOs to amp up Value with significantly higher cost savings and outcomes performance. More payment models are risk-based, changing economics for providers. Corporate health care and equity-backed practices are nabbing ACO physicians, making it hard for ACOs to sustain and grow. The next two years may be the […]
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 […]
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 […]
Three Lies and a Truth About ACO Data for APP Reporting
If you’re an ACO worried about APP Reporting, we get it. Your concerns about the feasibility and costs of aggregating data from multiple systems are completely valid. But don’t let data complexity hoodwink you into a simplistic solution that will cost you more than the data is worth. Your solution to data aggregation needs to […]
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 […]