Archive for the ‘Medicare’ Category

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 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®.

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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.

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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.

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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.

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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.

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

    October 20th, 2017 by Patricia Donovan

    Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

    In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

    Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

    In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

    The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

    The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

    Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

    Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

    According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

    CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.