Accounting for Risk Among Dual Eligible Beneficiaries

May 17, 2022acoRisk, risk management

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…

Using Data to Quantify a Key Pandemic SDOH: Social Isolation

April 18, 2022acoRisk, risk management, SDOH, social determinants of health

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…

How to Avoid an ACO Exodus — or Having No Takers in the First Place

January 24, 2022acoACO, ACOs, Downside Risk, Risk, risk management

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…

Improving Risk Prediction for Chronic Disease Management

December 28, 2021acoChronic Care Management, chronic disease, chronic disease management, chronic diseases, Risk, risk management

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….

Key Characteristics for Successful Downside Risk Contracting

October 15, 2021Garrett SchmittNo Commentscontracting, downside risk contracting, healthcare payers, KLAS, Payers, Population Health, Population Health Management, Risk, risk contracting, risk management, value-baed reimbursement, value-based care, value-based contracting, VBR

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…

AMGA to CMS: Rethink ACO Financial Risk Advancement in MSSP

July 6, 2021Garrett SchmittNo CommentsACOs, AMGA, APMs, CMS, COVID-19, MSSP, risk management, Value Based Reimbursement

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…

RECORDED WEBINAR: Managing the Unmanageable: Providers, Partners, and Patients

October 25, 2019Garrett SchmittNo CommentsACO, ACOs, Downside Risk, risk management, Webinar, webinars

 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…

RECORDED WEBINAR: How to Determine Your ACO’s Readiness to Move Toward Risk

June 11, 2019Garrett SchmittNo CommentsACO, ACOs, Downside Risk, risk management, Webinar, webinars

 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…

RECORDED WEBINAR: Leveraging ACO Waivers – An Investment Opportunity for Physician Led ACOs

May 14, 2019Garrett SchmittNo CommentsACO, ACOs, APM, Downside Risk, MACRA, Reinsurance, risk management, Risk Strategies, Surety Bonds, Webinar, webinars

 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…

RECORDED WEBINAR: Risk Adjustment Coding & Its Impact on ACO Performance

September 25, 2018Garrett SchmittNo CommentsACO, ACOs, Coding, Continuum Health, Downside Risk, Risk adjustment coding, Risk coding, risk management, Webinar, webinars

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…

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