Healthcare payers, providers, and other value-based care organizations face challenging questions as they work to improve treatment performance and cost. How healthy are patient cohorts and panels in a particular market? What treatments are the most effective for the most prevalent conditions in a population? How widespread are preventative screenings and vaccinations? Answering these questions…
The shift to value-based care (VBC) in the U.S. has been slow in coming, in large part because providers have continued to cling to the traditional “fee for service” (FFS) healthcare model that historically has worked well for them (if not always for the patient). Plus, it’s how they’ve always done business. But the inefficiencies…
I started 2021 with a new job and a new perspective to add my variety of experiences in the population health community as I joined Olio as the Vice President of Sales. For those not familiar with Olio, it is a software solution that makes it simple for hospital systems, physicians and payers to actively…
ABSTRACT Objectives: Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs’ choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and…
Limited funding and lack of reimbursement from payers are the top hurdles to patient engagement technologies, analytics and precision medicine, according to a survey of chief information officers. Healthcare providers plan to ramp up investments in telemedicine, patient portals and data aggregation capabilities but continue to struggle with how to fund these investments, a survey report from…
Accountable care organizations (ACOs) have become a major payment and delivery reform since they were introduced as a key component of the Affordable Care Act. Currently, there are more than 1,000 ACOs covering about 33 million lives across all payers—numbers that have steadily increased over time. The ACO model continues to evolve, but it seems…
Beginning in 2019, CMS will allow At-Risk ACOs, including Track 1+ and NextGen ACOs, to buy Stop-Loss independent from CMS’ own mandatory Stop-Loss. So what does this mean to your At-Risk ACO and your bottom-line and profits? This new CMS policy allows ACOs to buy stop-loss protection apart from CMS and its truncated (built in…
Participating in a physician-led accountable care organization can be an alternative for independent physicians who don’t want to consolidate with a hospital or health system. Indeed, physician-led ACOs show promising results and in various studies outperform ACOs led by hospitals and other large medical organizations. They also can provide a way for practices to handle increasing government regulation and can help…
In previous blogs, we have discussed programs whose goals are to improve patient outcomes through quality care while increasing provider efficiency. An additional program provided by CMS to help in these efforts is the Chronic Care Management (CCM) program. CMS has made CCM available to Medicaid ACOs as they seek to create savings for both…
Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals and health systems have flocked to value-based care strategies, such as population health management programs and high-risk patient interventions, the non-profit academic healthcare organization in…