As the aging population continues to shift into Medicare eligibility and toward Medicare Advantage programs, provider organizations are seeing their margins shrink to worrisome, unsustainable levels. For health systems, the time is now to pursue smart strategies for sustainability and growth. This was the main theme during an executive learning session at Becker’s 12th Annual…
University Hospitals’ accountable care organization had a math problem: More than 64,000 diabetic patients and only a few endocrinologists. Besides the lack of available endocrinologists, there is a warped perception of who should care for the estimated 129 million Americans with at least one chronic disease, according to Peter Pronovost, MD, PhD. “Across America, the…
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)…
Download Slides Salient Healthcare will discuss the importance of Chronic Care Management (CCM) and Principal Care Management (PCM) initiatives. In this webinar you’ll learn: – How properly utilizing CCM and PCM services can benefit patients, providers, and value-based organizations – How to implement improvements in your CCM/PCM workflow – How to quickly analyze your…
Healthcare organizations are stepping up to the plate when it comes to older adult care and chronic care management, according to a recent report from BDO Center for Healthcare Excellence & Innovation. The report, which was informed by an NEJM Catalyst survey, found that healthcare organizations are looking into home health services, strong chronic disease…
Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety of Medicare Advantage plans with more variation of health benefits, specialized cost-sharing designs, and…