Roji Intel Blog

Theresa Hush 0
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ACOsFuture of Health CareMedical Decision-MakingValue-Based Health Care
October 3, 2018

Why ACOs Must Build Trust with Providers and Patients to Meet Goals

As ACOs develop approaches to Value-Based Health Care, they are struggling with a key issue: lack of trust. How can providers commit to collective cost reductions that could have potentially negative revenue consequences for themselves individually or on their practices? If they don’t believe that the other players or their ACO are operating in the best interests of all involved, how can they participate in the ACO’s goals? Conversely, how can the ACO create effective leadership and collaboration if physicians are unwilling to commit to making the model succeed? Likewise, ACOs have to work harder to earn patients’ trust. Ask…
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Theresa Hush 0
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ACOsBundled PaymentsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
September 26, 2018

Five Strategies for Specialists: How to Safely Navigate ACO Arrangements

Amidst the furor over health care access and affordability, most consumers believe that the exceptional quality of America’s health care is due to specialty medicine. But Value-Based Health Care may well dramatically change specialty practice by putting specialists under financial risk arrangements. That’s because the most prestigious and flourishing providers in health care are also the most expensive for ACOs and health plans. That makes them a target for cost control. We have spoken about the need for ACOs to evaluate specialists carefully and ensure that specialists have input into ACO assessments of their cost and quality. Here we address specialists…
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Theresa Hush 0
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ACOsFuture of Health CarePerformance ImprovementValue-Based Health Care
September 19, 2018

ACOs Under Risk: Select Specialists Based on Collaborative Audit Process

ACOs have tiptoed into developing a physician network based on value. Building a full lineup of primary and specialty physicians to serve their patient population presents a daunting challenge. Even more relevant, until downside financial risk arrangements become mandatory, ACOs have been able to keep their physician networks inclusive; managing cost of care has been a lower priority than maintaining volume of patients or physician relationships. All that is poised to change as ACOs come under downside financial risk. The threat of budgeted expense levels that mandate repayment to Medicare or forfeiture of revenues to health plans will change traditional…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Future of Health CareMedicareValue-Based Health Care
September 12, 2018

The ACO Challenge: Your Essential Reading List to Prepare for Risk

The concept behind Accountable Care Organizations remains reasonable: Groups of health care providers take responsibility for total cost and quality of care for the patients and receive, in return, a portion of any savings they achieve. But as CMS Administrator Seema Verma made clear in announcing the Proposed ACO Final Rule last month, “Medicare cannot afford to support programs with weak incentives that do not deliver value. ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up,…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
September 5, 2018

Ready or Not, Providers Will Face Risk Under ACOs or Medicare Advantage

In any other industry, companies work hard to interpret purchasing and regulatory trends, and adapt quickly in times of change. Swift action is a hallmark of competitive business; those that linger risk failure. Examples of business adaptation are everywhere: a move to digital applications that help consumers and other purchasers connect and build loyalty; acquisition or spin-off of business services to enhance growth; immediate response to negative press. But in health care, the pace of change at the industry’s core—healthcare organizations and health systems—is slow and barely responsive to the market. Case in point: while government and private health plans…
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Theresa Hush 0
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ACOsFuture of Health CareValue-Based Health Care
August 29, 2018

Time Out

It's the last week of August, the run-up to Labor Day, and time to re-energize as we head into a period that promises even more intense health care reform. We at Roji Health Intelligence wish you a relaxing end of summer and a chance to recharge before we're all back in the fall fray. For those of you who would like to use a little vacation time to catch up on some reading, here are links to content that will come in handy as CMS continues to ratchet up the pressure on ACOs to assume risk: Download our free eBook, How…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareMedical Decision-Making
August 22, 2018

How ACOs Can Leverage Price Transparency To Create Value for Consumers

Health care consumers are being forced to assume a greater share of costs for treatment. But how can patients determine the value of health care services if they can’t compare costs? Lack of price transparency is a major obstacle to value-based medical decisions. In evaluating treatment options or services by different providers, consumers have no reliable means to monetize their choices. They are powerless to do anything about it—as yet. But that may well change as ACOs adapt to downside risk. Price transparency is a tool that exclusively benefits consumers, because health plans already, obviously, know the prices they negotiated…
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Dave Halpert 0
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ACOsFuture of Health CareValue-Based Health Care
August 15, 2018

Proposed ACO Final Rule: 10 Essential Takeaways from “Pathways to Success”

The Final Rule for the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO)  has been released, the first real revision since the program’s inception. Introducing the proposed rule, CMS stated that it is time to put real ‘accountability’ in Accountable Care Organizations, and this means that ACOs need to accept financial risk. The theme behind Pathways to Success is to end the one-sided risk model. ACO Savings Success Was Zero-to-Limited Under the Savings-Only Model Although ACOs were supposed to curb healthcare spending, data released earlier this year showed that CMS actually spent $384 million more, rather than saving $1.7…
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Theresa Hush 0
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Bundled PaymentsFuture of Health CareValue-Based Health Care
August 1, 2018

Five Steps for Successful Initiation of Bundled Payments and Episodes of Care

Everything about health care is complicated—its rules, science, service delivery, organizational systems, financing, and the relationship between all participants. So too will be the solutions for measuring and managing its value as determined by quality, outcomes and cost. To imagine that we can simply change one part of health care and effect change throughout the entire system is naïve, even ridiculous. Nonetheless, a recent analysis of how bundled payments failed to lower costs is being used as an example of why such reimbursements aren’t effective in changing incentives for high medical costs. While the analytical results show little difference in…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareMedical Decision-Making
July 11, 2018

Create Value for Consumers by Leveraging ACO Provider Choice

Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking services outside the ACO—for 60 percent of attributed total costs—providers argue that they can’t control total expenses, yet are on the hook for savings. They blame lack of coordinated care, duplicate tests and differences in the standard of care. Coordinated Patient Care Inside the Organization:…
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