Over half of dual-eligible Medicare Advantage beneficiaries experience the social determinants of health, revealing a need for better social health programming within the program, according to data presented by Avalere at ISPOR 2019. The data, which included administrative claims, CMS data, and other data linked with zip-code level information for nearly 2 million beneficiaries, revealed that more…
Although most Medicare ACOs are leveraging data analytics to inform their care coordination and population health efforts, many are also struggling with issues of data completeness and collection, revealed a report from OIG. Care coordination is a crucial part of keeping Medicare patients well, OIG noted, and health IT can help clinicians manage patients with complex diseases….
Nearly a decade has passed since Healthy People 2020 positioned social determinants of health (SDoH) at the forefront of healthcare reform. As defined by the report, SDoH are the “conditions in the environment in which people are born, live, learn, work, play, worship, and age, that affect a wide range of health, functioning, and quality of life…
The transition from fee-for-service to value-based care has chief financial officers (CFOs) thinking hard about the future — and many feel ill-equipped for what’s ahead. A recent survey found 87 percent of healthcare CFOs don’t believe their organizations are very well-prepared to manage evolving payment models using existing financial tools and processes. Similarly, 77 percent of CFOs…
The nation’s most fragile, at-risk patient populations are adults with disabilities. The Alliance for Integrated Care of New York oversees the healthcare needs of individuals with intellectual and developmental disabilities. It is the only Medicare Shared Savings Program-approved ACO of its kind in the United States. THE PROBLEM The Alliance for Integrated Care of New…
Many eligible healthcare organizations are still determining if they plan to enter the Center for Medicare and Medicaid Services’ (CMS’s) Pathways To Success Medicare Shared Savings Program (MSSP) for Jan. 1, 2020. As previously noted, the Notice Of Intent to Apply (NOIA) can be submitted between June 1 and June 28, 2019, with the final…
Patient care coordination tends to be easier for accountable care organizations whose participants are using a single electronic health record system, HHS’ Office of Inspector General said Wednesday. The need for reliable data-sharing has placed a burden on ACOs to either invest in the same version of an EHR system or rely on non-electronic means,…
Fee-for-Service (FFS) has been on a slow march toward risk-based reimbursement for two decades. But FFS has proven to be remarkably resilient—until now. In the last six months, Medicare has doubled down on creating new provider risk models for ACOs, specialists and primary care physicians. All of them have methods to ensure that providers are…
As we focus this month on the promise and potential of digital transformation across healthcare, it’s encouraging enough to take stock of the huge advances that have already been made in the past decade of the post-EHR era. But as we all know, there’s a still plenty of room for innovation and improvement as patients and…
Download Slides Has your Medicare Shared Savings Program (MSSP) ACO taken full advantage of the many waivers of federal fraud and abuse laws, such as the Stark Law and the Anti-Kickback Statute? During the webinar we will discuss the different types of waivers, what they are, which ones matter to you, how to use…