Roji Intel Blog

Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesQuality Payment ProgramValue-Based Health Care
August 14, 2019

Five Actions ACOs Should Take Now: Takeaways from Proposed CMS Rulemaking

Last week CMS released a proposed rule addressing revisions in the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP), along with a few other matters. Of 1,704 pages, only about 20 addressed ACOs issues directly. But ACOs should take a holistic approach to reading this proposed rule, as well as the proposed Outpatient Prospective Payment System (OPPS) rule. Competition Among Risk Models Will Strongly Affect the Course of Change With so many CMS programs and models now in flux, the whole is more than the sum of its parts. It’s worth the effort to pay attention to the…
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Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesValue-Based Health Care
July 24, 2019

Can ACOs Survive the Complicated New Landscape in Medicare Risk?

What a difference a year makes. In Spring 2018, many Accountable Care Organizations (ACOs) pondered a walkout over Medicare plans that included downside risk in ACO financials. Nonetheless, CMS finalized its plans to make provider risk a reality for all ACOs in its Pathways to Success overhaul of the Medicare Shared Savings Program (MSSP). ACOs’ lukewarm reception to the goal of compelled savings, however, was not forgotten. Fast forward to April 2019, when CMS announced five Primary Care Models to propel physician groups to adopt risk-based reimbursement directly—including capitation. Those models are now under fast-paced implementation, with application deadlines approaching.…
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Theresa Hush 0
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ACOsFuture of Health CarePrimary Care PracticesValue-Based Health Care
July 10, 2019

Can Medicare Primary Care Risk Models Work in Today’s Practice Environment?

There’s now no doubt that Medicare is eager to move forward with Value-Based Health Care and risk-based reimbursement. CMS has rolled out major changes to make Accountable Care Organizations (ACOs) risk-bearing and add attractive benefits to capitated Medicare Advantage plans. Add to that two new classes of Primary Care Risk Models that introduce risk-based reimbursement into the general provider population, which, CMS says, are designed to stimulate primary care: Primary Care First (PCF) and Direct Contracting (DC). But we also know, from early CMS statements on direct contracting, that it intended to find other mechanisms to move physicians into Value-Based Health…
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Theresa Hush 0
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ACOsBundled PaymentsFuture of Health CareRiskValue-Based Health Care
May 22, 2019

Can Provider Risk Cure High Medical Costs?

Fee-for-Service (FFS) has been on a slow march toward risk-based reimbursement for two decades. But FFS has proven to be remarkably resilient—until now. In the last six months, Medicare has doubled down on creating new provider risk models for ACOs, specialists and primary care physicians. All of them have methods to ensure that providers are held accountable for medical expenditure targets. Wait. Haven’t we been here before? What‘s different between now and the 1980s, when HMOs and provider risk first prevailed in the market—and then were purged as both ineffective and unpopular? Is provider risk a cure for high medical…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
May 8, 2019

How Will New Primary Care Models Affect Providers in VBHC?

Embraced by some provider groups and disparaged by others, CMS’s five new payment models for practices focused on primary care include much to consider. All reflect a key departure of Medicare’s Value-Based Health Care (VBHC) efforts to date: they are direct efforts by Medicare to transition physician practice revenues to risk without the necessity of ACO participation. The primary care models will affect both providers and patients. In this article, we’ll address the provider issues. How patient choice of care and outcomes for patients and patient populations will be affected deserves dedicated scrutiny in a future post. No Surprise that…
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Theresa Hush 0
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ACOsPerformance ImprovementRisk
April 17, 2019

Bootstrapped ACOs Facing Risk? Adopt Cost Strategies With Long Term RoI

The experimental phase of Medicare ACOs has been officially declared dead, per CMS. Going forward, ACOs must agree to take on financial risk for expenditures beyond their targets. That’s sobering news for the majority of ACOs still struggling to succeed. The reality is that most ACOs are bootstrapped—light on extra funding and dependent on existing tools to do more. In fact, about two-thirds of ACOs report that funding is their most significant challenge. And that is probably understated, since patient engagement problems (also reported by two-thirds of ACOs) and lack of data (reported by 40 percent) are remedied by solutions…
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ACOsFuture of Health CarePopulation HealthValue-Based Health CareWomen and Health Care
March 13, 2019

Women’s Health Research Needs an Infusion: How Health Systems and ACOs Should Help Correct Gender Disparities

Women receive health care that is below par, and the consequences are unnecessary morbidity and death. It is fact, not fiction—borne out by significant data that reveal disparities across many major conditions—that inattention to women’s unique symptoms, risk factors, disease biology and treatment effects are causing harm to women. Despite the reality, a poor body of research exists to point women’s health in the right direction. Value-Based Health Care (VBHC) assumes that we can measure providers’ delivery of health care against clinical standards. What if we don’t even know how half the population exhibits disease or responds to therapies? At…
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ACOsFuture of Health CareValue-Based Health CareWomen and Health Care
February 20, 2019

Providers, Take Note: Prepare for the Future Health Care of Older Women

Our review of women’s health care has called attention to disparities in risk factors and biological disease differences, treatment variances, and lack of adequate research. Gender and race have obscured perceptions of women’s symptoms, creating delays in diagnoses and treatments and even early death. A serious gap in gender-specific research and gender-analyzed data contributes to this profound lack of understanding of differential biology and treatment options. Even for conditions that are more specific to women, such as breast cancer and maternity, clinical care and research funding is heavy on front-end detection and prevention but fails to focus on women at…
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Dave Halpert 0
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ACOsAdvanced Alternative Payment ModelsRiskValue-Based Health Care
January 9, 2019

Pathways to Success: How CMS is Encouraging ACO Participation Despite Impending Financial Risk

CMS closed 2018 with a farewell to upside-only ACOs. Perhaps the biggest surprise in the “Pathways to Success” Final ACO Rule is its consistency with the Proposed Rule, which floated the revamped ACO Track back in August. Citing superior performance among two-sided participants, as well as the belief that upside-only tracks reduce patient choice and increase costs, CMS has finalized its proposal to push all ACOs into two-sided arrangements. Not coincidentally, this rule was simultaneously released with NextGen ACO model results, which showed that these 44 downside-risk ACOs saved $164 million. The rule, which will go into effect on July…
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Theresa Hush 0
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ACOsFuture of Health CarePopulation HealthValue-Based Health Care
November 28, 2018

Can ACO Population Health Solve Patient Engagement?

Personal attitudes inform our strategies for improving patient health. As ACOs move forward in Value-Based Health Care, attitudes about patients and providers set the stage for collaboration or conflict. And with ACOs taking on financial risk for patients, those attitudes and strategies can make the difference between success and failure. As we discussed in a previous post on the importance of involving physicians effectively in population health initiatives, alliances with physicians start with building trust and clinical leadership. Failure to do so will ultimately undercut both the ACO and their patients. So, too, must we be responsive to patients’ needs—not…
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