Roji Intel Blog

Theresa Hush 0
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ACOsEpisodes of CareRiskValue-Based Health Care
August 26, 2020

Straight Talk for Providers Adopting Capitation: Don’t Fly Blind Without the Right Data

Value-Based Reimbursement—once focused on incentives and shared savings—now more often means capitation. Whether adopting Medicare Alternative Payment Models (APMs) or contracting with health plans, physician groups and health systems have signaled greater willingness to adopt these new Risk payment models with their guaranteed payments for attributed patients. But here's the problem: If you don't have good data on your costs, you are flying blind. Let’s look at the myths and realities of what you really need both to measure your success under global capitation and to ensure that your Risk program is on track to be successful. Do You Need…
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Theresa Hush 0
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ACOsSpecialty PhysiciansValue-Based Health CareVideo
August 19, 2020

Video: Specialists and Value-Based Reimbursements

With specialists driving a significantly large share of ACO costs, consider how to use episode-based inquiries in your ACO strategy. The higher the financial risk for ACOs, the more critical it is to incorporate specialty episodes and other features effectively. Read more here. Founded in 2002, Roji Health Intelligence guides health care systems, providers and patients on the path to better health through Solutions that help providers improve their value and succeed in Risk.
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Theresa Hush 0
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ACOsEpisodes of CareValue-Based Health Care
August 12, 2020

How ACOs Can Control Costs with Physician Help, in 3 Steps. Really.

Health care has been drained emotionally and financially by the COVID-19 pandemic. Yet, in a surprising twist, that trauma has accelerated providers' willingness to adopt financial Risk. You may be one of many providers who have suddenly realized the value of predictable revenues like capitation. Receiving continual payments for attributed patients is appealing, especially when deferral of routine care has led many practices to the brink of failure. That’s why many providers are specifically considering capitation. For Groups with previous experience in managing risk pools, it's an easier decision. But if you represent an ACO that resisted CMS Rules to…
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Theresa Hush 0
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ACOsCOVID-19Future of Health CareValue-Based Health Care
April 15, 2020

Stretched to the Limit by COVID-19, Will Providers Get Relief from Medicare Value-Based Programs?

This article originally appeared in the April 2020 edition of Accountable Care News . COVID-19 continues its inexorable, exponential spread here in the U.S. Hospitals in New York City, now accounting for more than 7 percent of confirmed cases worldwide, have less than a quarter of the critical equipment and supplies needed to serve an overwhelming surge of patients. Our health care providers are facing impossible choices, even considering universal Do Not Resuscitate orders for patients with COVID-19. Less than one month ago, CMS was closing applications from providers willing to be part of a major movement to adopt financial…
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Theresa Hush 0
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ACOsDirect ContractingFuture of Health CareValue-Based Health Care
February 27, 2020

ACO Path to Viability: Direct Contracting May Be the Opportunity

What if your best route to viability was the high-risk path you feared the most, because that failure might destroy you? That's the question Accountable Care Organizations (ACOs) have been asking this week—whether to participate in Medicare's new Direct Contracting (DC) initiative. With a shift in payments from Fee for Service (paid per-provider service), to Global Capitation (paid per-beneficiary), DC completely changes the incentives for the health care system. Whether Direct Contracting is a boon or a bust to ACOs depends on their ability to control the costs of patient care long-term—and whether they have the leverage to do so.…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareNarrow NetworksValue-Based Health Care
October 30, 2019

Is Patient Lock-In the Next Step in Value-Based Care?

Hoping to safeguard survival under financial risk, health care providers are courting a contentious issue: how patients select primary providers. During the HMO heyday , health care risk economics depended on patient selection of primary providers as part of coverage selection that “locked” them into those PCPs and their referral networks. PCPs operated as gatekeepers to the rest of the health care system, authorizing services (or not) for specialists and other care. It’s well known that the HMO’s Primary Care gatekeeper model generated a backlash among private sector consumers. In fact, the gatekeeper was so unpopular with patients that it…
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Evelyn Herwitz 0
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ACOsAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Primary Care PracticesValue-Based Health Care
October 23, 2019

Roji News Roundup: Fall 2019 Edition

In a range of recent industry publications, Roji Health Intelligence CEO Terry Hush shares her insights on the latest moves by CMS and health care trends: Are Value-Based Models Helping or Hindering Care Delivery for Primary Care Providers AJMC Managed Markets Network, October 10, 2019 This article by Jaime Rosenberg summarizes Terry’s presentation at the National Managed Care Physicians 2019 Fall Managed Care Forum in Las Vegas. Value-based models continue to enter the health care system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a…
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Thomas Dent, M.D. 0
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ACOsSpecialty PhysiciansSpecialty ServicesValue-Based Health Care
October 9, 2019

How Physicians Can Navigate to Get Better Value from Specialty Services

In recent articles, we’ve discussed how Value-Based Health Care must help consumers make good decisions. Equally as important, CMS is now emphasizing how physicians should serve as navigators for their patients, providing information and guidance. Let’s take a closer look at how the triad of primary care physician, specialist consultant, and patient can effectively engage in a process that improves Value through better outcomes and lower cost. To focus on the shifting role of primary care physicians (PCPs), we use “physician navigation” to describe PCP actions to coordinate care for their patients. To emphasize continuity of care at stake for…
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Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesValue-Based Health Care
September 4, 2019

Will “Value” Help Consumers Choose?

In the emerging days of Value-Based Health Care (VBHC), “value” was defined by quality, cost, and experience of health care for patients—the “Triple Aim.” The movement’s initial defining goal: patients should be able to access high value health care services that improved outcomes, to get value for their dollars. Likewise, employers and other purchasers deserved similar value for their share of investment in health care benefit plans. Because incentives inherent in insurance and Fee-for-Service (FFS) payment systems reward volume over value, however, VBHC has also had a subagenda to make value pay for providers. But to reward better value instead,…
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Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesValue-Based Health Care
August 28, 2019

How Should Primary Care-Centric Physician Practices Choose A Path to Risk?

It’s an urgent question for most practices: How should physicians participate in value-based reimbursement? Traditional Medicare is moving assertively to physician payment models that include capitation and ceilings on spending, with revenue risk tied to patient care costs. Without a doubt, primary care practices are bearing the brunt of risk-based reimbursement. With the exception of specialty-aimed Bundled Payments, most payment models are primary care-centric. Patient costs are grouped and then attributed to their primary care physicians—regardless of whether the services were provided by those physicians or by specialists and hospitals—and those PCPs are then rewarded or penalized under various risk…
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