Tag Archives: CMS

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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The journey to value: Taking the first value-based steps with population health management-Part 1

In our previous Journey to Value post, we suggested four elements that organizations should consider as they as they determine their roadmap for value-based care. With a roadmap that accounts for market needs, financial impacts, provider network strategies and aligned incentives, organizations are ready to program the milestones around which they will convert to value-based […]
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Health care alliances require balance, clear goals

In our previous post, we discussed how health care alliances are becoming more prevalent as the industry evolves. There are tremendous benefits to forming alliances, but health care leaders need some solid skills and strategies to make them work. There are a number of challenges in making a health care alliance work. First, each alliance […]
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Calculating the incalculable

We often hear from state program integrity units that the work they do goes unrecognized. Yet when quizzed on how they promote their efforts — which could result in millions of dollars in savings and recoveries over just one year — they often reveal a limited understanding of how to calculate these savings. After all, […]
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