ACOs know that reducing costs is the key goal for Value-Based reimbursement. But strategies on how—or even whether—to engage physicians in that goal have not always been successful, to the detriment of all involved. Part of the problem is that provider revenues still stem from Fee-for-Service payments. Physicians are still rewarded based on meeting volume…
The Diabetes Eye Exam quality measure is commonly referred to as one of the most difficult care gaps to close. Since up to 50% of diabetic patients lack documentation of a retinal eye exam, ACOs and practices spend a significant amount of administrative time each year chasing charts to close this measure. At Topcon,…
The coronavirus pandemic highlighted the importance of value-based contracts and reimbursement and will continue to push the industry towards these models of care, according to healthcare stakeholder responses in Insights by Xtelligent Healthcare Media’s latest report. The Future of the Healthcare: Moving Beyond 2020 surveyed 363 healthcare industry leaders to understand their organization’s response to COVID-19, building…
Dive Brief: Clinicians who were affiliated with a health system had “significantly better” performance scores under the Merit-based Incentive Payment System than those who were unaffiliated, according to a JAMA study published Tuesday. The researchers noted, however, that the study does not determine whether affiliated physicians were providing better quality care, raising questions about the program’s…
Many other countries’ healthcare systems outperform ours for one simple reason: They place a much greater emphasis on primary care, which occupies the central place in their systems. “The evidence is that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes…
Risk Strategies provides a full suite of risk management services to ACOs and their physicians including Specific and Aggregate Reinsurance, Surety Bonds as a repayment mechanism in lieu of a Letter of Credit, Medical Malpractice Insurance, Reinsurance Captives for risk sharing, as well as Managed Care E&O and D&O/EPL coverages. Risk Strategies is a…
On August 11, 2020, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the new Community Health Access and Rural Transformation (CHART) Model as part of the President’s recent executive order. The Model is an incredible accomplishment for patients and healthcare providers in rural areas that face social determinants of health (SDOH) challenges,…
Recently CMS released the proposed rule for the 2021 Quality Payment Program (QPP), which covers both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). For MIPS, there was speculation leading up to the release of the rule about how the COVID-19 pandemic would impact the program for 2020 and 2021. A thorough analysis…
Most accountable care models focus on primary care. This leaves specialists on the outside looking in, stuck, for the most part, in a fee-for-service world. That’s despite the fact that specialty care accounts for about 70% of health care spend. Primary care-based models are designed to keep patients healthy and prevent disease. That makes sense –…
An excerpt from the NAACOS Newsletter for Members and Partners: MSSP ACOs should have received their performance results for 2019 from CMS. These results are embargoed until further notice from CMS, but ACOs may share results internally and with participants. Because of the two performance periods for many ACOs in 2019, “PY 2019” may refer to…