Tag Archives: CMS

Prepare for bundled payments by focusing on these six areas

As one year ends and another begins, we sometimes take stock of what’s changed or developed in the last 12 months. The online news site HealthPayerIntelligence.com did just that for the health insurance market by defining the top trends of 2016. Bundled payment models made the list.  Take 5 minutes to explore bundled payments in […]
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Care transitions can feel like changing the tires while driving

While providers may now see population health programs as key to value-based care success, many are struggling with implementing change in a way that affects outcomes. “It’s like the proverbial changing of the tires while driving down the road at 90 mph,” says Steve Griffiths, senior vice president of Health Care Analytics Consulting at Optum. […]
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MACRA is big for doctors. What about hospitals?

With the Medicare Access and CHIP Reauthorization Act replacing the sustainable growth rate, changes are coming for physicians. But will MACRA impact facility providers? Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates. Jay Hazelrigs, vice president and lead actuary at Optum, […]
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Who should make up the team that directs your move to accountable care?

As the U.S. health care system moves away from reimbursement models that reward volume and toward those that reward care coordination – traditional industry roles are blurring. • New #5in5 video: Fee for value requires revised relationships As this integration accelerates, organizations must build new governance structures that can provide strategic direction and accountability. That […]
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Not perfect, but practice makes progress for ACOs

Recently released results of the Medicare Shared Savings Program (MSSP) highlight the fact that Accountable Care Organizations need to be in it for the long haul. In August, the Centers for Medicare & Medicaid Services issued an update announcing that participating ACOs continue to show improvements in their ability to contain costs. Three hundred and […]
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Understanding a new, mandatory payment model

As the health care industry moves toward population health management, providers and payers are working to determine which value-based reimbursement models show the most promise. The Centers for Medicare and Medicaid Services gave the bundled payments a boost this year by making the model mandatory for a number of hospitals — first for hip and […]
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Addressing the possible effects of overlapping reimbursement models

At the core of bundled payments is the goal of improving coordination between all of the facilities and agencies a patient might visit or employ during one episode of care. But as health care providers adjust to this new reimbursement model, some are experiencing trouble coordinating bundled payments with other value-based care initiatives. In the […]
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2017 CMS Call Letter: Implications for MA and PDP plans

With CMS releasing the 2017 Final Rate Announcement for Medicare Advantage (MA) and Part D plan sponsors (PDP), plans must take the next steps to determine how the proposed changes will affect them financially and operationally. Doing so can help plans identify goals and prepare implementation strategies with respect to benefit strategy, operational compliance and […]
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The three Cs of provider directory data management

Comprehensive, robust provider directories are an invaluable tool for helping members find the right care. Yet maintaining this information is complicated when you consider: 20 percent of physicians change their address and/or phone number 30 percent change their health plan, hospital or group affiliations 5 percent have status changes (licenses, sanctions, retirement) False information can […]
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The journey to value: Taking the first value-based steps with population health management-Part 2

In the previous Journey to Value post, we discussed the usefulness of population health management (PHM) as a bridge between the volume and value worlds. This final post in the Journey to Value series discusses another program necessity as organizations journey to value: comprehensive data and sophisticated analytics. The fuel for the value-based care is […]
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