According to the American Heart Association, more than 1.5 million people in the United States experience a heart attack or stroke each year, with heart disease and stroke consistently among the top causes of death and disability. This costs the US healthcare system over $350 billion annually.1 However, heart attacks and strokes are, in many cases,…
In a post COVID-19 world, it’s more critical than ever for health plans to gain market share as well as decrease costs associated with poor outcomes. By achieving the 5 star rating in the Star Rating Program, Medicare Advantage prescription drug plans and stand-alone prescription drug plans are able to enroll members throughout the calendar…
The COVID-19 pandemic has significantly challenged clinician practices, hospitals, and all health care delivery organizations. Many such organizations have scrambled to build new capabilities and shift workflows to test, trace, and manage COVID-19 as well as remotely manage chronic conditions for their non-COVID patients. At the same time, health care delivery organizations are facing considerable…
Key Insights: Providers in alternative payment models (APMs) used population health strategies to slow the COVID-19 pandemic, showing the need for accountable care organizations (ACOs) in critical situations. The Centers for Medicare and Medicaid Services (CMS) has declared that COVID-19 expenditures will not be counted against existing ACOs’ performance metrics. For future ACOs: CMS has…
Learning objectives: Understand the impact of accurate and specific documentation/coding on HCC risk scores and quality outcomes Review common opportunities and/or barriers to accurate documentation/coding Describe best practice concepts related to documentation and coding integrity efforts and how to identify and start a pilot project Download Slides
One of the most common phrases in U.S. healthcare in the past few years has been this one: “one foot in the boat, one on the shore,” or, alternatively, “one foot in the boat, one on the dock.” Either way, the idea is that the leaders of patient care organizations—hospitals, medical groups, and health systems—are…
The dramatic growth of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic is having a significant impact on the physician-patient relationship. In March, when the pandemic took hold in the United States, telehealth visits increased 50%, according to Frost and Sullivan. With in-person medical visits associated with the risk of coronavirus infection, virtual visits emerged as a safe and…
Accountable care organizations (ACOs) are seeking answers from the Trump administration over the status of the Next Generation ACO Model set to expire this year and the upcoming Direct Contracting Model. The National Association of ACOs (NAACOS) sent a letter Tuesday to the Center for Medicare & Medicaid Innovation, which oversees the payment models, on…
There were more physician-led accountable care organizations (ACOs) than hospital-led ACOs by 2018, according to a study from Leavitt Partners. Physician-led ACOs accounted for approximately 45 percent of all ACOs in 2018, whereas hospital-led ACOs represented just 25 percent and joint-led ACOs represented 30 percent, revealed the study recently published in The American Journal of Managed Care. The…
Primary care practices need new ways of being paid if they are going to survive and thrive in the wake of the COVID-19 pandemic, several speakers said Wednesday during a webinar hosted by the Alliance for Health Policy. “Fee-for-service is simply not a system this is conducive or amendable to primary care being able to thrive…