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.
HealthEC CIO Sita Kapoor Discusses Actionable Data’s Role in Clinical Intervention
Dr. Nick van Terheyden, host of HealthcareNOW Radio show The Incrementalist, recently sat down with HealthEC CIO and Chief Data Scientist, Sita Kapoor, to discuss high-volume data processing in healthcare and the role of artificial intelligence in delivering clinically actionable insights to caregivers.
The True ROI of Population Health Management
In most parts of the United States, the use of value-based care (VBC) arrangements are growing, and health systems today typically participate in a diverse VBC portfolio. Nevertheless, the proportion of total net patient revenue derived from these programs is usually small. Based on CHIME’s Most Wired Data, an average of 26% of hospital revenue in the US comes from value-based care contracts. And some organizations are still questioning what the ROI is for their VBC investment. We at HealthEC believe that health systems can still achieve short- and long-term ROI by focusing on three key strategies: Better aligning value-based...
Three Medicaid Challenges in the Wake of COVID-19
Influx of New Medicaid Participants Millions of unemployed Americans are losing employer-sponsored healthcare coverage. Without income or affordable insurance options, a large percentage of the U.S. population now find themselves eligible for Medicaid, many for the first time in their lives. As state Medicaid agencies and managed care organizations (MCOs) shore up systems to welcome a tsunami of new enrollees, there are three areas to quickly assess: financial, operational and clinical. By using all available state data and resources, programs can be ready for the surge ahead. Healthcare Innovation recently interviewed HealthEC regarding the rapid influx of new Medicaid participants...
Power Over Uncertainty: Five Steps for ACOs to Take Now
The COVID-19 pandemic has created great uncertainty for Accountable Care Organizations (ACOs). From the complete demise of value-based care payment models to loss of shared savings incentives, ACO concerns abound and rumors run rampant. Every day our nation’s ACO leaders are being bombarded with both superfluous perceptions and stark realities. And the pressure shows.
Infrastructure, Staffing, and Culture Work Together to Navigate Risk
Medical staff members are often the last to be informed of new risk-based contracts. However, they are usually the first to feel the financial impact of taking on greater risk. With our nation’s medical staff leaders and professionals in mind, I recently coauthored an article for the March 2020 issue of Medical Staff Briefing (MSB) in collaboration with Cliff Frank, interim executive director at Shore Quality Partners in Somers Point, New Jersey.
Behavioral Health: Looking Back at Open Minds Performance Management Institute
While the world of physical medicine has seen a steady progression in the development and adoption of value-based care models and payer contracts, behavioral health has been on a slower road to adoption. At the 2020 Open Minds Performance Management Institute earlier this month, payers, providers, and vendors convened to discuss a number of topics related to where behavioral health services are on the road to value, and how the sector can move forward more quickly. There are certainly some issues that need to be addressed.
Health Plans, Mobile Applications, and Closing the Referral Loop
In my last blog, I talked about the communication gaps between primary care providers and specialists when it comes to referrals, the need for healthcare IT vendors to close this referral loop, and HealthEC’s success in already doing so.
The Social Determinants of Health – More Than Just Buzzwords
While the introduction of the proposed Medicaid Fiscal Accountability Rule (CMS-2393-P) grabbed headlines at last week’s National Association of Medicaid Directors (NAMD) Fall Conference, discussions about social determinants of health could also be considered front-page news.
Closed Loop Keeps Primary Care Providers and Specialists on the Same Page
As a patient, have you ever felt a bit confused about next steps after your primary care provider (PCP) refers you to a specialist?