Our recent analysis of Medicare Fee-For-Service claims data continues to confirm what we have believed for years—post-acute care plays an essential role in reducing unnecessary healthcare spend in the U.S. Shifts towards value-based care and an influx of baby boomer beneficiaries promises a multitude of opportunities for home health, hospice, and skilled nursing organizations to…
Some 50 percent of hospitals in the United States are racially segregated, meaning the patient populations they serve do not reflect the demographics of their communities, according to the latest analysis from healthcare thinktank Lown Institute which was emailed to journalists. This imperils national efforts for addressing health equity. The cities with the most racially…
As we discussed in our first blog post on ACO REACH, one of the concerns about Direct Contracting was patient risk coding abuse (also called “coding intensity”). Risk coding, or risk scoring, is used by Medicare Advantage (MA) to determine the payment an MA plan will receive for a given beneficiary. Risk scoring is also…
The performance of Medicare Accountable Care Organizations has been mixed. When ACOs were first launched, the goal was to save costs and improve quality, with the Centers for Medicare and Medicaid Services offering two models with two distinct levels of risk. Now, data shows that while cost savings do, in fact, occur under both models, quality decreases….
Two years into the global COVID-19 phenomenon, it’s become very clear that patient care organizations in the United States have taken a big financial hit from the pandemic. Not only has caring for COVID-19 patients turned out to be extremely expensive, the pandemic has also scrambled hospital operations in particular, as numerous nurses, physicians, and…
On February 24th, the Centers for Medicare & Medicaid Services (CMS) revealed the highly-anticipated fate of the Innovation Center’s (CMMI) Direct Contracting model options, announcing a redesign of the Global Professional Direct Contracting (GPDC) Model and the permanent cancellation of the Geographic Direct Contracting (“Geo”) Model. The revamped and rebranded GPDC model—now called Accountable Care…
The Patient Protection and Affordable Care Act placed a greater emphasis on models of reimbursing physicians and hospitals that hold them accountable for both quality and cost of care, an approach commonly referred to as value-based purchasing (VBP). The accountable care model is a particular VBP approach that has expanded rapidly. Within a Medicare Shared…
The types of social determinants of health that medical providers may identify in their patients vary, meaning it will take numerous social determinants of health interventions to support patient wellness. But with these hospital- or clinic-based social service referrals being somewhat in their nascency, not every organization has a solution for every social determinant of…
In today’s post-acute care landscape, growth and success will look different for everyone. Market conditions, resources and budgets, company goals – each of these plays a role in determining the go-to-market strategy for your organization. And to truly understand and define these areas, you need to first start by looking at the market intelligence and…
Download Slides The number of increasing at-risk contract lives combined with decreasing nursing availability is leading to the perfect storm. Topics of discussion: Identify the clinical and financial importance of managing the rising-risk portion of your population and best practices for building these cohorts Describe how to sustainably operationalize care management teams…