Contributor: CMS Can Seize Opportunities to Fix the Rural Glitch, Risk Adjustment Caps in MSSP

October 10, 2021Garrett SchmittNo CommentsCMS, Medicare, Medicare Shared Savings Program, MSSP, risk adjustment, rural glitch, rural health

In August, Administrator Chiquita Brooks-LaSure and other leaders from CMS shared their priorities for the next 10 years. In particular, they called out the importance of reducing inequities in health care, striving to get all Medicare and Medicaid beneficiaries in accountable care relationships, and designing financial incentives that will encourage participation in new payment and…

New bill seeks to reverse slide in ACO participation with more shared savings

July 20, 2021Garrett SchmittNo CommentsACO participation, ACOs, APMs, health legislation, MSSP, news, risk adjustment, Shared Savings, Value in Health Care Act

New bipartisan House legislation aims to boost the amount of shared savings that accountable care organizations can receive from the federal government to halt a slide in participation that has occurred over the past two years. The Value in Health Care Act reintroduced on Tuesday includes new requirements to study health outcomes for Medicare beneficiaries…

Using AI and social determinants of health to identify risk

June 14, 2021Garrett SchmittNo CommentsAI, Data, healthcare outcomes, provider incentive, risk adjustment, RTI International, SDOH, SRFs, variable importance

There is increased recognition for better methods to measure, predict and adjust for social risk factors in healthcare and population health. Current performance and quality measures generally do not take SRFs into account in the bonus/penalty structure, nor are SRFs generally included in most risk adjustment formulas. This can lead to unintended consequences, including the…

Why PCPs Should Focus on Coding and Documentation in Value-Based Care Programs

May 12, 2021Garrett SchmittNo CommentsCoding, documentation, PCPs, risk adjustment, vbc

Each year, a growing number of providers are entering value-based care arrangements, including primary care providers (PCPs). Given their holistic view of patients, PCPs are the best types of clinicians to drive value-based care. Medicare’s Primary Care Transformation programs and many payer-developed value-based care contracts are proof of the move for PCPs to be at…

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