Archive for the ‘Medicare’ Category

Population Health Tactics to Boost an ACO’s Medicare Annual Wellness Visit Rates

February 9th, 2018 by Patricia Donovan

One of the most important revenue opportunities for primary care physicians, and for population health nurses under their direct supervision, is the Medicare Annual Wellness Visit (AWV), advises Tim Gronninger, senior vice president of development and strategy, Caravan Health. The AWV offers an opportunity to check a number of Medicare quality boxes, including preventive check-ins, vaccinations and health screenings, to help make sure that a beneficiary’s medical needs are being met.

Here, Gronninger suggests ways that physician practices can improve all-important AWV rates.

Much of increasing annual wellness visit rates is about how to manage expectations of the practice and of the patient. You’ll be chasing your tail a lot if you are looking at your data and saying, “Well, these 1,000 patients haven’t had an annual wellness visit. I’m going to make a thousand phone calls, and then I’m going to make a thousand follow-up phone calls to try to schedule them all.”

It is very important for a practice to create a process where you have the time, the space and the plan, so that when a patient comes in the door for an Evaluation and Management (E&M) visit, the patient is handed off seamlessly to a nurse coordinator to complete an annual wellness visit at the same time. Obviously, different patients will require different handling. But we have found a very high acceptance rate from that approach among patients of clients that we work with.

It’s something that many patients take for granted, that their clinician knows this about them already. However, many times, the physician in practice doesn’t know whether the patient is up to date on their mammograms or other types of screenings.

Editor’s Note: Caravan Health’s ACOs saved more than $26 million in the Medicare Shared Savings Program (MSSP) and achieved higher than average quality scores and quality reporting scores in 2016.

Source: Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success

ACO population health

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

CCMI’s Primary Care Initiatives Produce Modest, Mixed Results

February 8th, 2018 by Melanie Matthews

Comprehensive Primary Care Initiative Analysis

Comprehensive Primary Care Initiative Analysis: Mixed, Modest Results

The Center for Medicare & Medicaid Innovation’s (CCMI) Primary Care Initiatives have produced modest and mixed results, according to a final review of the program conducted by Kennell and Associates, Inc. and RTI International and released by CMS.

The six CMMI initiatives included in the review are the Comprehensive Primary Care (CPC) initiative, the Federally Qualified Health Center (FQHC) Advanced Primacy Care Practice demonstration, the Independence at Home (IAH) demonstration, the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, the State Innovation Models (SIM) initiative, and the Health Care Innovation Awards Primary Care Redesign Programs (HCIA-PCR), which CMS identified as the most focused on primary care redesign.

Initiative practices did make large strides toward becoming Patient-Centered Medical Homes (PCMHs) or advanced primary care practices. While less than 10 percent of initiative FQHCs had any PCMH recognition status prior to the initiative, 70 percent achieved NCQA Level-3 recognition by the end of the initiative. Similarly, the CPC evaluation found that CPC initiative practices improved their PCMH Assessment scores by about 50 percent.

While the review did not find consistent impacts across the initiatives or by setting within initiatives for any of the four core outcomes identified by CMS: fee-for-service Medicare hospital admissions, 30-day readmissions, outpatient ED visits, and Medicare expenditures, some of the initiatives did report some positive outcomes.

Of the 22 more granular initiative settings (seven CPC regions, FQHC as a whole, six HCIA-PCR awardees, and eight MAPCP states) for which cumulative results through Year 3 were available, 10 settings experienced improvement relative to their comparison group for at least one of the four core outcome measures at a significance level and three of these settings (two CPC regions and HCIA TransforMED) experienced improvement on at least two core outcomes.

Across four initiatives (CPC, MAPCP, HCIA-PCR, and FQHC), analyses indicated that the aggregate impacts on the core outcomes were small and not statistically significant.

Certain population subgroups and practice types across initiatives experienced more favorable outcomes, according to the analysis. Specifically, beneficiaries originally eligible for Medicare due to disability and beneficiaries with poor health (highest quartile of baseline HCC risk scores) experienced slower growth in Medicare expenditures. However, disability status and HCC risk score were not associated with statically significant impacts on overall rates of hospitalizations or ED visits, and non-dually eligible beneficiaries and those who were not originally eligible for Medicare due to disability experienced lower rates of 30-day readmissions.

The analysis also found slower growth in Medicare expenditures and lower rates of inpatient admissions and ED visits among practices with fewer than six practitioners and also among practices that were not multispecialty practices.

Other key findings from the analysis:

  • There are advantages to both state-convened and CMS-convened initiatives;
  • Practice-level factors are important in addressing transformation challenges; and
  • Initiative-level supports also helped practices meet transformation challenges.

Infographic: Medicare Home Health Beneficiaries

January 29th, 2018 by Melanie Matthews

Home healthcare patients are among the poorest, sickest and most vulnerable beneficiaries in the Medicare program, according to a new infographic by the Partnership for Quality Home Healthcare.

The infographic compares a traditional Medicare beneficiary with a Medicare home health beneficiary and factors that demonstrate why Medicare home health beneficiaries are financially vulnerable.

The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI A care transitions management program operated by Sun Health since 2011 has significantly reduced hospital readmissions for nearly 12,000 Medicare patients, resulting in $14.8 million in savings to the Medicare program. Using home visits as a core strategy, the Sun Health Care Transitions program was a top performer in CMS’s recently concluded Community-Based Care Transitions (CBCT) demonstration project, which was launched in 2012 to explore new solutions for reducing hospital readmissions, improving quality and achieving measurable savings for Medicare.

The The Science of Successful Care Transition Management: Leveraging Home Visits to Improve Readmissions and ROI explores the critical five pillars of the Arizona non-profit’s leading care transitions management initiative, adapted from the Coleman Care Transitions Intervention®.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

8 Findings from CMS Medicare Chronic Care Management Assessment

January 26th, 2018 by Patricia Donovan

YNHHS embedded care coordination

Medicare Chronic Care Management services reduced healthcare utilization and likelihood of hospital admissions for CCM recipients, according to a new CMS report.

Beneficiaries who received Chronic Care Management (CCM) services experienced a lower growth rate in healthcare expenditures compared to those who did not receive CCM services, according to a new evaluation report from the Centers for Medicare and Medicaid Services (CMS).

The lower rate of growth in total Medicare per beneficiary per month (PBPM) expenditures ranged from $28 to $74, after removing the average monthly CCM fee of $29.

The Medicare and Medicaid payor released the report on the diffusion and impact of CCM payment during the program’s first two years of implementation.

In January 2015, CMS introduced a separately billable non-face-to-face Chronic Care Management service (CPT code 99490). The goal of CCM is to improve Medicare beneficiaries’ access to chronic care management in primary care.

Here are seven more findings from the evaluation report:

  • Over 684,000 beneficiaries received CCM services from January 2015 to December 2016, the first two years of the new payment policy.
  • The decreased rate of growth was driven by decreases in expenditures for inpatient hospital services, skilled nursing facility services, and outpatient services; the decreased expenditures were partially offset by increased expenditures of home health and professional services. Researchers similarly found a lower rate of growth among CCM beneficiaries in hospitalizations and all-cause emergency department visits.
  • Receipt of CCM services was also associated with a reduced likelihood of an admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection, and pneumonia among CCM beneficiaries, relative to the comparison beneficiaries.
  • A total of 16,549 individual healthcare providers billed for a total of $105.8 million in CCM fees in the first two years of the new payment policy.
  • Chronic Care Management beneficiaries were generally concentrated in the South and had poorer health status than the general Medicare fee-for-service (FFS) population.
  • About 19 percent of beneficiaries only received one month of CCM services; however the majority of beneficiaries received between four and ten months of CCM services, on average.
  • Primary care physicians (PCPs) billed for 68 percent of CCM claims and 42 percent of CCM billers were solo practitioners. Individual providers billed for $105.8 million in CCM fees during the first 24 months of the program and, on average, managed about 47 patients per month. However, the median number of patients was 10, indicating that the average was skewed by a small number of providers delivering CCM services to many beneficiaries. This translates to about $300 in CCM fees per month for providers furnishing CCM services to 10 beneficiaries.

The report did not examine the impact of 2017 CCM policy revisions that significantly increased payment for providing CCM to more medically complex patients.

Read the complete CMS Chronic Care Management evaluation report.

In Successful ACOs, Population Health Focus Paves Way for Shared Savings Payouts

January 25th, 2018 by Patricia Donovan

Physician practices toiling in fledgling ACOs and obsessing over shared savings that have not yet materialized, take heart: population health offers multiple revenue streams for accountable care organizations waiting for the “gravy” of accountable care.

“Gravy” is the way Tim Gronniger, senior vice president of development and strategy for Caravan Health, refers to ACO shared savings payouts, which he says can take considerable time to accrue.

“It is literally two years from the time you jump into an ACO before you have even the chance of a shared savings payout,” Gronniger told participants in Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast now available for replay.

Obsessing over shared savings is one of the biggest mistakes hospitals in ACOs can make, he added.

This delay is one reason Caravan Health urges its ACOs to adopt a population health focus, whether pursuing the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) or the Medicare Shared Savings Program (MSSP).

Gronniger’s advice is predicated on his organization’s experience of mentoring 38 ACOs. In 2016, Caravan Health’s ACOs saved more than $26 million in the MSSP program and achieved higher than average quality scores and quality reporting scores, according to recently released CMS data.

Walking attendees through a MACRA primer, Gronniger underscored the challenges of the MIPS program, one of three tracks offered under the Quality Payment Program. “Barring a really exceptional performance on MIPS, you can’t even break even over the next few years on physician compensation,” he said.

In the meantime, ACOs should utilize recently rolled out Medicare billing codes, from the annual wellness visit (AWV) to advanced care planning, to generate wellness revenue. With proper planning, reengineering of staffing and clinical work flows, a practice could generate anywhere from five hundred to one thousand dollars annually per eligible Medicare patient, Gronniger estimates—monies that offset the cost of constructing a sustainable ACO business model.

To back up this population health rationale, Gronniger pointed to data from an ACO client demonstrating the impact of a cohesive PHM approach, including the use of trained population health nurses, on completion rates for preventive screenings. For less top-of-mind screenings like falls assessment and smoking cessation, completion rates rose from negligible to near-universal levels, he said.

“These are recommended sets of screens that are required by CMS, but that also help ACOs with quality measures,” he added.

Gronniger also shared examples of dashboards, scorecards and roadmaps Caravan Health employs to help keep client ACOs on track. An ACO success strategy involves “a lot of dashboarding, checking in, and discussion of problems and barriers, discussion of solutions, and monthly and quarterly measurement and reporting back,” he said.

Beyond coveted shared savings, ACO participation offers significant non-financial benefits, including quality improvements under both MSSP and MIPS standards, availability of ACO-specific waivers, and access to proprietary performance data.

Overall, ACO participation can make providers more attractive both to commercial contractors and to potential patients perusing Physician Compare ratings in greater numbers.

Gronniger ended by weighing in on the recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the MIPS program.

Infographic: Medicare Advantage Trends

January 10th, 2018 by Melanie Matthews

As medical groups and large systems transition to risk-based models, they expect nearly 60 percent of federal revenues will come from risk-based products (bundled payment, Medicare Advantage (MA), Medicaid Managed Care Organizations, and Medicare Accountable Care Organizations) by 2019, according to a new infographic by AMGA.

The infographic shows the anticipated the growth of MA as well as what this means for healthcare providers.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Advancing Medicare and Medicaid Integration

December 18th, 2017 by Melanie Matthews

There are more than 11 million individuals who receive services from both Medicare and Medicaid. State policymakers and their federal and health plan partners are increasingly seeking opportunities to improve Medicare-Medicaid integration for these dually eligible beneficiaries, according to a new infographic by the Center for Health Care Strategies.

The infographic explores the reasons to integrate care for dually-eligible individuals; features of effective programs; and factors influencing state investment in integrated care.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid PopulationTo locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to ‘street case management’ to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC’s innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

From Last Place, Bronx Communities Now Prize Culture of Health

December 7th, 2017 by Patricia Donovan

Barely eight years ago, the Bronx landed at the very bottom of the first county health rankings issued by the Robert Wood Johnson Foundation (RWJF) —the least healthy of 62 New York counties, to be exact.

It didn’t help that as a borough, the Bronx topped a few other lists compiled by New York officials, including the highest prevalence of obesity and diabetes and the top consumers of sugary drinks.

Rather than discourage this diverse borough, however, these rankings galvanized residents and a number of Bronx organizations, including the Bronx Institute of Health, to partner and examine facets of community life to see where health might be improved. Under the hash tag and rallying cry of #Not62, the coalition’s reach has extended into Bronx schools, housing and even local food stores known as bodegas as it attempts to reimagine and enhance community health.

During Innovative Community-Clinical Partnerships: Reducing Racial and Ethnic Health Disparities through Community Transformation, a November 2017 webcast now available for rebroadcast, Charmaine Ruddock, project director, Bronx Health REACH, charted the path to some of the innovative community health partnerships forged by her organization.

Formed in 1999 with a grant from the Centers for Disease Control and Prevention (CDC), Bronx Health REACH (shorthand for “racial and ethnic approaches to community health”) is charged with eliminating racial and ethnic disparities in health outcomes, particularly those related to diabetes and heart disease, in Bronx populations. Since its inception, Bronx Health REACH has grown from five to more than 70 community-based organizations, schools, healthcare providers, faith-based institutions, housing, social service agencies and others.

“Those founding partners were particularly concerned that Bronx Health REACH not be seen as a program per se, but as a catalyst for creating a movement around health and well-being in the community,” explained Ms. Ruddock.

From early focus groups, Bronx Health REACH determined that community members not only felt disrespected by the healthcare system, but also powerless to advocate on their own behalf for better services. Those findings helped to shape the Bronx Health REACH mission and subsequent efforts.

Outreach began at the organizational level, such as examining the way a local church provided meals at church events. The coalition brainstormed ways to prepare those meals in a healthier manner, supplementing the church’s work with nutrition training that quickly spread throughout the faith community. From there, the program applied that approach to the food offered during school meals and via vending machines, and eventually within the local food retail environment, which consists principally of bodegas.

Today, the scope of Bronx Health REACH is broad, encompassing street safety, physical activity and overall wellness, among other areas. Its early work with bodegas has grown from demonstrations and tastings of healthy foods to the formation of a Bronx bodega work group and a new Healthy Bodegas marketing initiative. It has engaged farmers’ markets in its objective of increasing healthier food options. To that end, healthcare providers now issue “prescriptions” for fruits and vegetables that are accompanied by ten-dollar coupons.

The transformation is visible in the community, Ms. Ruddock notes. Today, some previously padlocked playgrounds are open; murals by visiting artists that adorn the walls of local housing are left alone for all to enjoy.

However, a great deal of work remains. “We have given ourselves as a goal that by 2020, we will establish a multi-sector infrastructure working with housing groups, economic development groups, and others as the first step in addressing many of the health-related factors and issues,” explained Ms. Ruddock.

But for now, the enthusiasm and contributions of Bronx residents have not gone unrewarded. In 2015, just five years after receiving its disappointing health ranking, the Bronx was one of eight recipients of the RWJF’s Culture of Health prize. The prize is awarded to communities that work to ensure residents have the opportunity to live longer, healthier and more productive lives.

Listen to Charmaine Ruddock explain how early findings from focus groups helped to shape Bronx Health REACH initiatives.

Infographic: Medicare Costs

December 6th, 2017 by Melanie Matthews

Beneficiaries in Original Medicare spent an average of $5,680 on healthcare in 2013. Half of all beneficiaries spent at least 17 percent of their income on their health, according to a new infographic by the AARP.

The infographic breaks down where Medicare beneficiaries spend their healthcare dollars and how age and health status impact spending.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Community Health Partnerships Can Change the Culture of Poverty: 2017 Benchmarks

November 28th, 2017 by Patricia Donovan

Community health partnerships address unmet needs, providing services related to transportation, housing, nutrition and behavioral health.

For residents of some locales, community health partnerships (CHP) —alliances between healthcare providers and local organizations to address unmet needs—can mean the difference between surviving and thriving, according to new CHP metrics from the Healthcare Intelligence Network (HIN).

“We could not survive without community partnerships. Our patients thrive because of them. They are critical to help change the culture of poverty that remains in our community,” noted a respondent to HIN’s 2017 survey on Community Health Partnerships.

Partnerships can also mean the difference between housing and homelessness. According to the survey, more than a quarter of community health partnerships (26 percent) address environmental and social determinants of health (SDOH) like housing and transportation that can have a deleterious effect on population health.

“To date, we have housed 49 families/individuals who were formally homeless or near homelessness,” added another respondent.

“Social health determinants are more important than ever to managing care,” said another. “Community health partnerships make a big impact when it comes to rounding out care.”

Motivated to improve population health, healthcare providers are joining forces with community groups such food banks, schools and faith-based organizations to bridge care gaps and deliver needed services. The majority of community health partnerships are designed to improve access to healthcare, say 70 percent of survey respondents.

Eighty-one organizations shared details on community health partnerships, which range from collaborating with a local food bank to educate food pantries on diabetes to the planting of community gardens to launching an asthma population health management program for students.

Seventy-one percent conduct a community health needs assessment (CHNA) to identify potential areas for local health partnerships. Priority candidates for 36 percent of these partnerships are high-risk populations, defined as those having two or more chronic medical conditions.

Overall, the survey found that 95 percent of respondents have initiated community health partnerships, with half of those remaining preparing to launch partnerships in the coming year.

Other community health partnership metrics identified by the 2017 survey include the following:

  • Local organizations such as food banks top the list of community health partners, say 79 percent.
  • The population health manager typically has primary responsibility for community health partnerships forged by 30 percent of respondents.
  • Foundations are the chief funding source for services offered through community health partnerships, say 23 percent. However, funding remains the chief barrier to community health partnerships, say 41 percent.
  • Forty-five percent have forged community health partnerships to enhance behavioral health services.
  • Two-thirds attributed increases in clinical outcomes and quality of care to community health partnerships.
  • Forty-four percent reported a drop in hospital ER visits after launching community health partnerships.

Download an executive summary of results from the 2017 Community Health Partnerships survey.