As the United States continues to move toward value-based care, a great deal of attention has been given to vulnerable patient populations. Patients with higher needs (and correspondingly higher costs) are among those who would benefit most from healthcare improvement efforts, but those costs can represent significant risk to networks that stake their revenue on…
Loneliness and social isolation rose alarmingly during the COVID-19 pandemic as lockdowns proliferated and in-person gatherings were discouraged. A critical social determinant of health (SDOH), social isolation is estimated to have increased by 6.7 percentage points during the pandemic. To help combat this and other SDOH issues, providers and payers are turning to data analytics. Several companies have…
The question of whether ACOs should be forced to accept “downside risk” — in effect pay a penalty if they exceed certain spending benchmarks — has bedeviled CMS’ ACO programs and ACO programs in general. Seema Verma, the Trump administration’s CMS director, pushed for more downside risk, and the administration’s Pathway to Success program shortened…
For better chronic disease management, Boston University researchers recommend replacing the term “race” with underlying factors that indicate an increased risk for heart attacks and strokes. “If other factors (instead of race itself) determine the risk differences, then the prediction equations should incorporate those factors that cause the differences in predicted risk between the races, rather than race itself….
Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the…
The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a letter to CMS. CMS’ decision to defer the automatic advancement of ACOs in the MSSP and allow ACOs to remain in their current risk level of the BASIC Track’s…
Download Slides During this presentation is discussed how to better manage the more difficult individuals, and get the right people on the bus. How to identify providers that don’t fall in line Reconfiguring your network to manage partners that adversely affect ACO performance Strategies to manage difficult or un-cooperative patients Visit the HealthEC Exhibit…
Download Slides As provider organizations prepare for Pathways to Success and determine their best approaches for aligning with CMS’s accelerated risk path, ACO’s have important decisions to make in order to ensure their success under CMS’s value-based initiatives, including how to: – Determine the right performance track and when to select it – Find…
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…
Download Slides Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and…