Roji Intel Blog

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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
August 24, 2021

Cost Savings Aren’t the Only Objective for ACOs: Growth Matters, Too

Keeping within expenditure limits is a top priority for most ACOs for Medicare. That makes sense. Savings are the main distinguishing feature of an ACO arrangement, as opposed to straight Fee-for-Service reimbursement. ACOs that accept downside risk can’t afford to exceed the expenditure target. It’s in their best interest to create initiatives to cut costs and control expenses—especially for services outside the ACO, such as post-acute care. But a cost strategy only focused on trimming expenses will likely fail the ACO in the long run. Why? Medicare ACOs face an annually decreasing expenditure limit that mandates them to lower costs…
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ACOsConsumers & PatientsFuture of Health CareValue-Based Health Care
July 29, 2021

Five Important Health Care Trends that Consumers Should Track

In the world of health care, change is never-ending. Politics, government regulation, scientific advancement, technology, and the economics and financing of health care foster shifts to reshape how care is delivered and how much it costs. Many of these shifts are completely invisible to us as health care consumers. But they also drive what is happening to and around us, determining availability and affordability of physicians or other services. This came home to me last month when we had friends over for dinner, and the conversation turned to our work. I mentioned Accountable Care Organizations and got blank stares. The…
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ACOsFuture of Health CareMerit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
December 9, 2020

7 New Value-Based Health Care Directions You’ll See in 2021

Everyone who's reeling from 2020 is hoping for light in 2021. Health care, especially—systems, hospitals, clinical practices and their providers—wants the pain to stop. What might lie ahead for health care next year? Here's what we're thinking about the near future, and what you should watch for in 2021. 1. Health care providers will be fortified. If one thing is clear from the election results, it's that relief is coming to help providers on the pandemic’s front line. Money won't be free-flowing, but it will be targeted to areas of financial distress. We should expect initiatives to centralize purchasing and…
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COVID-19Future of Health CareRacial Inequities in Health Care
June 3, 2020

A Pandemic Recovery for Health Care Means Addressing Racial Inequities

Health systems, eager to bring patients back, are using new methods to reach out—mass emails to reassure patients of clean and safe facilities, targeted phone calls to reschedule cancelled appointments and procedures, broadcast television announcements and social media ads that strive to convince patients not to defer care any longer. Providers hope they can recover by encouraging their patients to return. But the pandemic has changed the landscape in health care, in ways that health systems didn't expect. Significantly, it has laid bare the fact that Black Americans are dying in far larger numbers from COVID-19, driven by more severe…
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COVID-19Future of Health CarePopulation HealthSpecialty Services
May 14, 2020

Size is Now a Problem That Large Hospitals and Health Systems Must Solve

For two decades, consolidation in health care has been a strong industry trend. Championed by hospitals and hospital-organized systems, care is now less independent and more centralized, especially in urban settings. Widespread acquisitions of physician practices and towers of specialty services, diagnostics, and treatment seem to have forever changed the health care landscape. But in the era of COVID-19, that configuration of big health care is proving to be a problem. Large systems started turning off the spigot of specialty and non-essential services almost immediately once the community spread of COVID-19 became apparent. As these organizations now try to entice…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
January 15, 2020

Can Consumers Be the Answer to Health Care Cost Control?

In the intense ramp-up to accepting Value-Based Health Care payment models that include financial risk, providers have implemented an array of technologies and programs to improve cost performance. They are in a race against time. Capitation is re-emerging as a dominant payment type under Medicare Value-Based Primary Care Models and commercial contracts. Alternative Payment Models demand payback for excess costs. In the crunch, however, the most important health care goal is getting lost: how to reduce long-term costs while improving patient outcomes. The most effective solutions will require more than just technology. They will require provider-consumer partnering, facilitated by consumer-focused…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
January 9, 2020

Get the eBook: Turn Health Care Chaos into Value – Give Voice to Providers and Consumers

Are we on a real path to reducing health care costs and improving our citizens' health? Those were stated goals in the early 2000s that developed into what is now called Value-Based Health Care (VBHC). VBHC has come to mean a major reform effort to slow the pace of cost increases through changes in incentives for both providers and health care consumers. So far, however, the gains have fallen short of expectations. VBHC reforms require significant changes in the role of providers and consumers in order to succeed. These role changes are evolving too slowly. Health care costs continue to…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
December 18, 2019

Bottom Line: Can Consumers Survive Value-Based Health Care?

As 2019 nears its close, health care has reached a crossroads. Value-Based Health Care was intended to clarify consumer choices and motivate providers to offer high value services that improved outcomes, as well as to improve patient access to those services. But has that goal been realized? Has anything really changed? Or are health care consumers even worse off than before? Since September, we've been evaluating the consumer perspective of Value-Based Health Care, examining whether the movement is helping consumers achieve affordability, better choices, and good quality. We’ve focused on two central questions: Is Value on the right track? Has…
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Consumers & PatientsFuture of Health CareMedical Decision-Making
November 21, 2019

How Aching Joints Can Teach Consumers to Question the Evidence

As explained in our last article, there’s more to managing personal health care costs than concentrating on insurance payments and uncovered costs. As health care consumers, we’d all benefit from learning how to determine whether the value of the services—as delivered by a given provider—is worth the cost, potential risk, and benefits. Here, again, are the four key questions: Request evidence for new or continued treatment; Ask about your providers' cost and quality performance and service standards; Question what doesn't seem right about your experience, diagnosis, and treatment; Request episode-based cost information. There's a good chance that some consumers will…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
November 13, 2019

How to Manage Your Health Care Costs – Beyond Just Coverage Costs and Gaps

Consumers are rapidly becoming aware that costs for health care coverage extend well beyond premiums, copays, and deductibles—costs such as additional charges for out-of-network physicians and facilities. There is also a growing understanding that different providers charge varying costs for services—and that other hidden variables can increase the final bill for treatment. But consumer health care costs are not only a price issue. The cost of health care is the final sum of many decisions that are—at least partly—controllable by consumers or providers. Unfortunately, most consumers don't know all the factors that make up health care costs, and why those…
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