Roji Intel Blog

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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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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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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Future of Health CareRiskSpecialty Physicians
August 7, 2019

Risk Payment Models Will Fuel Growth of Equity-Backed Physician Practices

Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses, although some have managed to achieve success solely by being excellent clinicians in their fields. Patients, however, are quick to see the flaws along with higher costs—hence complaints about customer service, poor billing practices, and difficulty communicating. But clinical practice success, up until now, has been measured by the yardstick of Fee-for-Service reimbursement: higher incomes through patient volume and services. Hospital purchasers of physician practices adopted the same benchmarks of success. Even as hospital…
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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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Dave Halpert 0
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Future of Health CareMerit-Based Incentive Payment System (MIPS)Quality Payment ProgramRiskValue-Based Health Care
November 7, 2018

The Final 2019 Quality Payment Program Rule: A Slow (but Steady) Push to Risk

Brew a pot of coffee! CMS has released a 2,378-page Final Rule covering the 2019 performance year for the Quality Payment Program, including the Merit-Based Incentive Payment System (MIPS). Those who dive into this document will gain insight into CMS’s vision for the future. It seems tortuous to suggest “reading between the lines” when there’s already so much laid out in black-and-white, but recognizing the context within the rule enables you to prepare for the future—spelled R-I-S-K. The Final Rule is very close to what was proposed back in July and has been similarly justified—CMS continues to cite Meaningful Measures, Patients…
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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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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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Theresa Hush 0
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ACOsFuture of Health CareSpecialty PhysiciansValue-Based Health Care
May 9, 2018

ACOs and Specialty Physicians: How Episodes of Care Create a Win-Win Cost and Quality Strategy

Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about specialist-generated costs for most ACOs currently depends on the ACO’s structure. ACOs that are hospital-led or formed by multi-specialty health systems or networks may be less apt to look to specialty care for savings, except when the specialists are outside the ACO. Physician-led groups with…
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Thomas Dent, M.D. 0
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AttributionClinical Data RegistryFuture of Health CareMeaningful UsePerformance ImprovementValue-Based Health Care
January 12, 2016

Public Health Reporting for Specialists: Avoiding Penalties Isn’t the Only Reason to Comply

At the heart of CMS’s Public Health Reporting Requirements for Meaningful Use is a basic premise: EMR technology must facilitate tracking of public health trends and long-term outcomes improvement. That is why all providers in the Meaningful Use program, regardless of specialty, are now being required to engage in public health reporting to avoid a penalty. Many specialists don’t see the point of reporting for public health reasons or find it too difficult. While it’s true that specialists face some specific challenges that require dedicated reporting to fit their clinical operations and to avoid professional and financial risks, there are…
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