Tag Archives: Medicare

MACRA requires knowledge of qualities of “good” data

Medicare is allowing physicians and group practices to set their own course toward compliance with the Medicare Access and CHIP Reauthorization Act, or MACRA. But regardless of the path chosen, accurate measurement is key. That’s because the most basic level of participation requires physicians to submit data on one quality measure and one improvement activity […]
Read More »

Better outcomes and reduced costs for our frailest populations

Patients living in skilled nursing facilities (SNFs) are a small subset of Medicare beneficiaries. But these clinically complex individuals generate nearly two times the average medical expense for all Medicare members, according to The Henry J. Kaiser Family Foundation. By promoting more intense attention to this institutional population, health plans can drive better care and […]
Read More »

Analytics provides “one report card” for physicians

In today’s health care, there are a lot of players – and a lot of payers, each with their own standards for evaluating physicians and the care they provide. As Greg Kile, CEO of the analytics firm Populytics, explains in an Optum® video, his company’s top 10 payers have 176 different metrics. Being washed over […]
Read More »

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 […]
Read More »

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. […]
Read More »

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, […]
Read More »

Medicare Advantage risk adjustment: How deep is the well?

Health plans realize the value of comprehensive risk and quality programs to meet the needs of providers and members. These programs are also critical to addressing increasing regulations and the focus on quality. For Medicare Advantage in particular, it’s important to address quality as defined by the Star Rating system and the bonuses that are […]
Read More »

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 […]
Read More »

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 […]
Read More »

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 […]
Read More »