Large language models, a form of artificial intelligence, are generating a lot of hype in healthcare circles, primarily because of their potential to transform and improve various aspects of healthcare delivery and management. The buzz also is driven by rapid advancements in AI and machine learning. But while there’s significant potential, challenges and ethical considerations…
Risk Adjustment Factor and CMS-HCC Model The Centers for Medicare & Medicaid Services (CMS) utilize Hierarchical Condition Category (HCC) risk adjustment models to predict forthcoming healthcare costs for Medicare Advantage patients, considering health status and demographic factors. The Risk Adjustment Factor (RAF) score determines CMS payments to health plans per patient. Medicare Advantage Organizations (MAOs)…
Chicago-based Medical Home Network (MHN), a nonprofit organization focused on transforming care in the safety net, is partnering this year with 64 federally qualified health centers (FQHCs) in seven states to participate in two CMS value-based programs: ACO REACH and the Medicare Shared Savings Program (MSSP). MHN provider partners participating in the NeueHealth Premier ACO…
ABSTRACT Objectives: To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations. Study Design: Claims-based retrospective cohort study. Methods:…
Payers, health systems, and health professionals will experience expanded accountability for performance in closing health disparity gaps in 2024. With advances in public health research, many modern health challenges have been attributed to how social and ecological factors, commonly referred to as social determinants of health (SDOH), can influence health outcomes. To measure the progress…
As the healthcare landscape continues to evolve, there’s a clear trend towards value-based care (VBC). This significant shift, which places a premium on patient health outcomes, diverges from the traditional fee-for-service approach. The aftermath of the COVID-19 pandemic has mainly catalyzed the adoption of VBC models, highlighting the importance of care quality and effectiveness rather…
With the push towards health equity and away from a fee-for-service model of healthcare, risk-bearing organizations have an opportunity to join the ACO REACH (Realizing Equity, Access, and Community Health) program. In the program, Centers for Medicare & Medicaid Services (CMS) encourages ACO REACH participants to work with underserved communities. Further, the program guidelines mandate…
Download Slides Are you worried about the burden of APP reporting? Do you feel that data aggregation and all-patient reporting is too expensive and risky, but Medicare CQMs seems like a lot of extra work? Let’s examine your options for APP Reporting from a cost and burden standpoint, and see what will be the most…
Dive Brief: Accountable care organizations in traditional Medicare are prospering, federal regulators said in new data released Monday. However, participation in Medicare’s largest value-based care program has stayed generally the same over the last five years. Roughly 13.7 million Medicare patients this year — nearly half of beneficiaries on traditional Medicare — are in accountable care…
The Coding Intensity Factor (CIF) is intended to establish revenue neutrality in the Realizing Equity, Access, and Community Health (REACH) program and causes all accountable care organizations (ACOs) to pay for increases in program-wide risk scores. Because the CIF is calculated after the application of the +/-3% floor and ceiling, some REACH ACOs could contribute…