Navigating the Transition to Value-Based Care: Addressing Fears and Embracing Risk in ACO REACH

Garrett Schmitt

Established healthcare organizations, whether it be health systems, accountable care organizations, or independent provider groups often grapple with the dilemma of fully embracing risk. Fears of taking downside risk and capitation payments are intimidating given the known unknowns regarding participating in fully risk-based programs, regardless of whether one operates within the Medicare Shared Savings Program…

How ACOs Can Harness AI’s Transformative Potential

Garrett Schmitt

Everywhere you look today, artificial intelligence (AI) is making an appearance and offering to do something you already do smarter, faster or just a little more efficiently. Or it’s allowing new, exciting ways to look at old problems. Across health care, it’s opening up new opportunities to weigh risks and improve diagnoses, personalize medicine and…

Kaiser Permanente Is Deploying Innovaccer’s Value-Based Care AI Across Washington

Garrett Schmitt

Kaiser Permanente announced a significant AI partnership this week aimed at enhancing value-based care. The West Coast-based health system is deploying Innovaccer’s healthcare AI platform and population health management tools — starting with its Washington market and potentially expanding to new markets in the future. This initial deployment, which will serve about 650,000 Washington patients,…

Can ACOs Flex While Supporting Specialty Care?

Garrett Schmitt

On March 19, 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model—the Accountable Care Organization (ACO) Primary Care Flex Model (ACO PC Flex Model)—which will test primary care capitation in CMS’s permanent ACO program, the Medicare Shared Savings Program (MSSP). Under the model, monthly prospective primary care payments to MSSP ACOs will…

Choosing the Right QPP Reporting Method for MSSP ACOs in 2025

Garrett Schmitt

Navigating the Shift: Transitioning from CMS Web Interface to APP As the 2024 performance year ends, MSSP ACOs (Medicare Shared Savings Program Accountable Care Organizations) are bracing for new reporting obligations under the Quality Payment Program (QPP). The Centers for Medicare and Medicaid Services (CMS) is gearing up for a complete transition to digital quality…

ACOs seek to remove “anomalous” spending from financial benchmark calculations

Garrett Schmitt

A coalition of 11 groups representing accountable care organizations (ACOs) and other health care stakeholders wants the government not to consider “anomalous” Medicare spending that is outside ACOs’ members control when determining if an ACO has exceeded its annual spending benchmarks In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid…

RECORDED WEBINAR: The Medicare Advantage V28 transition: What we learned in year 1

Garrett SchmittNo Comments, ,

 Download Slides Explore the impact of V28 on revenue, uncover key diagnoses, and learn mitigation strategies. With V28 in full swing, it’s a great time to review the experience of our first year. We’ve been digging into the data to understand what it’s telling us about strategies that are successful and unsuccessful in managing…

RECORDED WEBINAR: How Buena Vida y Salud ACO uses predictive targeting to help keep patients healthy at home

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 Download Slides Dr. Sheila M. Magoon, Family Practice provider and clinical expert, will share how her system navigates complexities of rising costs and utilization of their aging patient population. Their strategy consists of pinpointing specific sub-populations based on predicted future risks of utilization, complication, and developing chronic diseases and deploying tailored interventions that reduce…

Patient Engagement Is Essential for Achieving the Goals of Value-Based Care

Garrett Schmitt

As noted in the first article in this series, traditional value-based (VBC) care models are largely focused on economic incentives to healthcare providers and facilities. Many VBC organizations lack the infrastructure in place or scale to integrate factors that impact how patients interact with the healthcare system, engage with care providers, or adhere to treatment…