The Department of Health and Human Services (HHS) regularly refines its policies and operational guidelines in an ongoing effort to better serve patients and support sustainable value-based care delivery. To that end, HHS and CMS recently announced three important updates: Revisions to HHS risk adjustment model algorithm software Changes to cost-sharing reductions (CSRs) Deployment of…
In creating your strategies for cost control, your ACO must consider how to reduce Total Per Capita Cost (TPCC) while ensuring the financial survival of your ACO and participating providers. This balancing act is the dilemma facing all providers adopting Value-Based Care: how to achieve more savings while replacing revenue lost from services. Here’s how…
The Impact of Meaningful Patient-Provider Relationships In the evolving landscape of healthcare, the dynamic between patient and provider is increasingly scrutinized. As technology continues to integrate into everyday healthcare practices, it’s essential to assess whether these tools foster meaningful relationships or if they inadvertently encourage a more transactional approach. Drawing from Adam Grant’s insights on…
Value-based behavioral health involves measuring an organization’s impact on a patient’s health. How impact is defined and translated into value varies depending on several factors. At the broadest level, the various levels of care acuity require different approaches. They may also have advantages and disadvantages when it comes to value-based care in the first place….
The release on July 10 of the proposed Calendar Year 2025 Medicare Physician Fee Schedule from the Centers for Medicare & Medicaid Services (CMS) prompted discussions among healthcare industry professionals. On July 16, the Washington, D.C.-based Primary Care Collaborative (PCC) hosted an online discussion with CMS leaders about how Medicare Part B payment policy could…
In the U.S. health system, various determinants and factors such as income, race, education, gender, sexuality, and even zip code significantly influence our health outcomes. These factors affect how healthy we are, the frequency and severity of illnesses, our access to care, and even our life expectancy. Consider these stats: Non-Hispanic Blacks/African Americans have 2.4…
Accountable care organizations (ACOs) face unique burdens to comply with CMS’s new quality reporting requirements as summarized in this 2021 MedCity News article. Challenges are particularly acute for ACOs that delayed conversion from CMS’s Web Interface to the new electronic clinical quality measures (eCQM) quality reporting. Many ACOs have made the change. But many have…
Meticulous documentation is the name of the game for nursing home operators looking to keep up with Minimum Data Set (MDS) changes and maintaining a good rating in the Five-Star Quality Rating System. This is especially because inaccurate or insufficient data could affect a facility for at least a year in the future. Leaders in…
Momentum for value-based care grows as physicians gain more experience with value-based models and commit to improving outcomes – rewarding patients and providers alike. Investing in value-based care allows physicians to spend more time with their patients and, in doing so, deliver high-quality care that takes patients’ needs and preferences into consideration. Patients, providers and…
Accountable care organizations (ACOs) need better communication to explain how they are helping Medicare patients achieve better health at a better overall cost. The National Association of Accountable Care Organizations (NAACOS) and the Health Care Transformation Task Force published “Reimagining Beneficiary Engagement in Accountable Care Models.” The white paper outlines how ACOs, the longest-standing alternative…