The Top 10 Changes ACOs Need to Know ACOs participating in shared savings programs face a number of opposing forces in 2021. From a decline in the number of Medicare beneficiaries to new CMS regulations to force downside risk sooner, ACOs are carefully weighing their options in the year ahead. In fact, the number of Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP) dropped by 7.7% in 2021 as reported by Modern Healthcare. This nascent decline raises a red flag for everyone involved in the programs; MSSP and the Quality Payment Program ( QPP). Both programs are...
Chilmark Research Affirms that Community Connections Address SDoH
Addressing SDoH through Community Referrals A 2020 report from Chilmark Research highlights the impact of social determinants of health (SDoH) on the healthcare system and spotlights HealthEC as an effective solution in seamlessly connecting healthcare providers with community partners with significant reductions in unnecessary healthcare expenditures and dramatic improvement in patients’ overall health and well-being. Chilmark presented the findings during an industry webinar on December 20, 2020. Medical care is estimated to account for only 10-20% of the modifiable contributors to health outcomes for a population. Yet, data integration and collaboration between clinical providers and community partners remains the biggest...
How to Negotiate Value-Based Contracting in Healthcare
Negotiating value-based reimbursement & Value-based contracting is a complex process for healthcare providers. Organizations participating in value-based agreements need to consider the specific population covered under the contract, the particular reimbursement model used, and which quality and utilization measures will be tracked. And because each contract varies, negotiators rely on every available insight to truly understand where bonuses, cost savings and better patient outcomes for each population are possible.
CMS Boosts States’ SDOH Efforts: New Opportunities Focus on Medicaid and CHIP
State health officials received a much-needed New Year’s present on January 7, 2021 from CMS. Cash-strapped and resource-drained after nine months of a pandemic, states health officials welcomed the center’s tidings of guidance, funding, and services to better address social determinants of health (SDOH). The 51-page Medicaid Director’s letter from CMS provides leadership and guidance to drive the adoption of SDOH strategies, further improve beneficiary health outcomes, reduce health disparities, and lower overall costs in Medicaid and Children’s Health Insurance Program (CHIP). CMS lays out programs, benefits and services that can more effectively improve population health and reduce the cost...
How Health IT Can Mitigate the Effects of Physician Burnout
Exhaustion. De-personalization. Lack of Efficacy. These three cardinal symptoms characterize physician burnout, as defined by the World Health Organization, and measurable by the Maslach Burnout InventoryTM developed by Christina Maslach and her colleagues at the University of San Francisco in the 1970s. Our nation’s clinicians have expressed burnout for several years due to personal and professional stressors. According to Medscape’s 2019 National Physician Burnout, Depression and Suicide Report, 44 percent of physicians reported feeling burned out. Another 15 percent reported some level of depression. Personal stressors due to family responsibilities, time pressure and lack of control are commonplace for everyone....
Prince George’s Health Alliance & Health Department Address SDOH, Improve Public Health
HealthEC customer Prince George’s Health Alliance was recently interviewed by Healthcare Innovation regarding their collaboration with the Prince George’s County Health Department. In a community-wide effort around social determinants of health (SDOH), the two organizations are working together to improve public health, reduce hospital visits and cut hospital charges per patient from $18,929 to only $8,699. In the article, representatives from both organizations share their strategies and tactics for effective public health management, especially during the pandemic. The four foundational components of their successful collaboration are: Implementation and shared use of a centralized population health technology platform Collaborative patient assessments,...
Senior Isolation During COVID-19 and What Healthcare Should Do About It
I recently authored an article for HITConsultant.net about the challenges facing our nation’s seniors during COVID-19. Senior isolation is a health risk affecting at least one quarter of seniors over 65. Social isolation is a risk factor for poor aging outcomes, including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, and even death. Add COVID-19 to the mix and it is easy to see how seniors have become healthcare’s most important at-risk population.
Expanding High-Acuity Clinical Care in the Community
Healthcare has been forced to stretch their muscles during the COVID-19 pandemic. For both safety and efficiency, providers must be creative in caring for a growing patient population. After reading CMS’ recent announcement of the Acute Hospital Care at Home program, it is clear that clinical care will continue to expand beyond the four-walls of the hospital.
Social Determinants of Health (SDOH), the 4th Realm of Healthcare
Communities across the United States are looking for better ways to manage mental and behavioral health disorders, with the recognition that social determinants of health (SDOH) are inextricably linked with an individual’s mental health status. This is particularly true among individuals with comorbid medical conditions. Broadly put, SDOH represent the complex political, socioeconomic, and cultural circumstances into which individuals are born and live their lives, that impact health and well-being. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) stress that effective chronic disease management must address the physical or built environment; access to healthcare,...
2020 Shared Savings Program Benchmarks – your Organization Meet the Mark?
Back in June we conducted a webinar titled Power Over Uncertainty – Five Steps for ACOs to Take Now, where we outlined five steps we suggested ACOs take to improve quality outcomes, while also ensuring organizational sustainability. With CMS’s release of the 2020/2021 Shared Savings Quality Measure Benchmarks this month, I wanted to share some of my insights around how ACOs could be impacted on the cost benchmarking from a historical respective, the regional adjustment and the few benchmarking methods utilized by the commercial payers.