Posts Tagged ‘accountable care organization’

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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HINfographic: Measuring Accountable Care Success

July 31st, 2017 by Melanie Matthews

What are the hallmarks of a flourishing accountable care organization (ACO)? Robust clinical outcomes and satisfied patients, say respondents to the 2017 ACO Survey by the Healthcare Intelligence Network. Adoption of ACOs more than doubled in the last four years, and ACO leadership shifted from physician-hospital organizations to integrated delivery systems.

A new infographic by HIN examines what other measures healthcare organizations use to measure ACO success, ACO physician staff size and ACO administration trends.

The accountable care organization, or ACO, has become a cornerstone of healthcare delivery system and payment reform by raising the bar on healthcare quality and reducing unnecessary costs. There are now more than 700 ACOs in existence today, by a 2017 SK&A estimate.

2017 Healthcare Benchmarks: Accountable Care Organizations, HIN’s fourth compendium of metrics on ACOs, captures ACO operation in today’s value- and quality-focused healthcare environment. This 50-page report, now in its fourth edition, delivers actionable data from healthcare companies who completed HIN’s fourth comprehensive ACO assessment in May 2017.

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Infographic: Accelerating Adoption of Accountable Care

October 31st, 2016 by Melanie Matthews

Continued financial pressure within the U.S. healthcare system are driving the need for increased adoption of value-based healthcare payment models, including accountable care organizations, according to a new infographic by the Accountable Care Learning Collaborative at West Governors University.

The infographic examines the impact of value-based payment models and how increased collaboration could improve results.

2015 Healthcare Benchmarks: Accountable Care Organizations Even before CMS published its agenda for moving Medicare into value-based payment models like the accountable care organization (ACO), the number of public and private ACOs had exceeded 700, by a Leavitt Partners estimate. Already, more than 20 percent of healthcare organizations plan to participate in Medicare’s latest accountable care model, the Next Generation ACO, in the coming year.

Support for CMS’s latest alternative payment offering is just one of the ACO metrics contained in 2015 Healthcare Benchmarks: Accountable Care Organizations. HIN’s fourth annual compendium of metrics on ACOs captures how ACOs are faring in an industry rapidly shifting away from fee for service to one that rewards quality, the patient and population experiences, and cost efficiencies. Click here for more information.

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Infographic: The Forced March to Value-Based Healthcare

June 13th, 2016 by Melanie Matthews

The Centers for Medicare and Medicaid Services (CMS) is accelerating the transition to value-based care by engaging physicians and providers with a battery of new value-based programs and quality incentives. With commercial insurers following CMS’s lead, the government is setting a rapid pace of change.

A new infographic by Oliver Wyman provides a history of CMS’s value-based initiatives, pilots, and targets.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: Medicare ACO Road Map

April 22nd, 2016 by Melanie Matthews

Provider participation in accountable care organizations (ACOs) is becoming the new normal. As of January 1, 2016, there were 434 ACOs in the Medicare Shared Savings Program. More than 160,000 providers now participate in an MSSP ACO. These organizations now serve 7.7 million Medicare beneficiaries residing in 49 of the 50 states, according to a new infographic by PYA.

The infographic provides a road map to the MSSP destination of shared savings.

With the nation’s leading accountable care organizations already testing the waters with CMS’ newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy. With a looming application deadline for a 2017 start for the next round of Next Generation ACOs, the clock is ticking. And, with one approved Next Generation ACO, River Health ACO, already departing the program effective February 1st, the “Go-No Go” decision has become even more critical.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016, now available for replay, Healthcare Strategy Group’s Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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HINfographic: Next Generation ACO Model

November 18th, 2015 by Melanie Matthews

One fifth of healthcare organizations are gearing up to participate in CMS’ new ‘Next Generation’ ACO Model in the year ahead, according to 2015 metrics from the Healthcare Intelligence Network (HIN). In the Next Generation ACO model, participants can take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings.

A new infographic by HIN examines ACO participation by model type, the top challenges to ACO creation, current and planned ACO participation levels and success criteria.

2015 Healthcare Benchmarks: Accountable Care Organizations Even before CMS published its agenda for moving Medicare into value-based payment models like the accountable care organization (ACO), the number of public and private ACOs had exceeded 700, by a Leavitt Partners estimate. Already, more than 20 percent of healthcare organizations plan to participate in Medicare’s latest accountable care model, the Next Generation ACO, in the coming year.

Support for CMS’s latest alternative payment offering is just one of the ACO metrics contained in 2015 Healthcare Benchmarks: Accountable Care Organizations. HIN’s fourth annual compendium of metrics on ACOs captures how ACOs are faring in an industry rapidly shifting away from fee for service to one that rewards quality, the patient and population experiences, and cost efficiencies. Click here for more information.

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Infographic: 2015 ACO Trends

December 22nd, 2014 by Melanie Matthews

Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased, according to a new infographic by Perficient.

There are 700+ ACOs in the United States and two-thirds of the U.S. population now live in a region served by an ACO. The infographic also looks at ACO success factors and the role of data analytics in an ACO.

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable CareWhile widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP). In this 25-page report, Karen Furbush, business consultant, and Heather Jelonek, chief operating officer, accountable care organization, John C. Lincoln Network, describe the sources combed by the ACO to address operational and technological challenges during the pre-launch period, and how these efforts and resulting data enhanced quality measurement and reporting for the JCL ACO.

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Infographic: Accountable Care Strategies to Improve Quality and Lower Costs

October 24th, 2014 by Melanie Matthews

There are four key strategies for healthcare organizations to improve the quality of care they provide and lower costs in an accountable healthcare model, according to a new infographic by The Commonwealth Fund.

Accountable Care Strategies to Improve Quality and Lower Costs

7 Patient-Centered Strategies to Generate Value-Based Reimbursement Healthcare companies seeking a roadmap to richer reimbursement should begin with the seven value-based healthcare priorities for 2014 identified by the healthcare C-suite: population health management, care coordination, integrated care delivery, e-health and telehealth, access to care, health and wellness, and dual eligibles. 7 Patient-Centered Strategies to Generate Value-Based Reimbursement explores the seven healthcare areas ripest for development in 2014, prioritized by 136 respondents to HIN’s ninth annual Trends & Forecasts survey.

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3 2014 Trends for Health Plans

January 21st, 2014 by Jessica Fornarotto

Influencing primary care, aggregating and mining data, and embracing bundled or episode-based payments are three trends that will influence health plans in 2014, predicts Catherine Sreckovich, managing director in the healthcare practice at Navigant Consulting.

HIN interviewed Sreckovich on these trends prior to her presentation during HIN’s tenth annual webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: Where will data analytics take health plans in the coming year, and how will this shape population health management offerings?

(Catherine Sreckovich): We’re certainly hearing a lot about big data, and it will be an integral approach to merging this practice’s or population’s health, the ability to aggregate and mine data is going to be an essential capability for health plans for their predictive models. And the outputs of these models are going to enable the health plans to identify and stratify their members or population health. Member and patient demographics can also inform consumer engagement strategies to support population health. And the analytics are going to inform the effectiveness of different care management interventions and consumer engagement strategies.

HIN: Health plan case managers embedded alongside providers has become almost a de facto model. How will payors influence primary care delivery in the year to come?

(Catherine Sreckovich): There is a number of approaches evolving right now and that will continue to evolve as payors attempt to influence primary care delivery. One is the use of patient-centered medical homes (PCMHs) and other integrated models to expand the payor’s role as the primary care case manager.

In addition to paying primary care providers to hire case managers and care coordinators, payors are pushing for shared savings arrangements with these primary care providers, such as within an accountable care organization (ACO), and to push them to manage the care for those with chronic conditions.

We’re also seeing payors paying for primary care physicians to become certified PCMHs and to implement electronic health records (EHRs), either by paying directly for the certification of the technology or by adding bonus payments to their FFS rates.

Payors are also paying for incentives for primary care physicians to offer wellness programs such as smoking cessation or weight loss programs and are trying very hard to influence where and to whom primary care physicians refer their patients by giving them information about the cost and quality of other provider types, such as specialists and hospitals.

And we will continue to see that payors will target the larger primary care physician practices with whom they have a critical mass of members to achieve enough savings to offset the added costs of incentives, bonuses and shared savings arrangements. As a result, we expect that some of the smaller primary care practices will likely not receive the same level of support and push from payors.

In another example, we see payors increasingly partnering with non-traditional providers, such as retail-based clinics and community health centers to offer easily accessible primary care at lower costs. And this will certainly be an opportunity to address some of the physician supply shortages that we anticipate seeing in the next year or so as more and more people have access to healthcare insurance and coverage.

Finally, another approach payors are using is to offer members access to virtual doctor visits via webcam, for example, and other telemedicine approaches that are giving individuals access to these primary care providers to increase access to convenient and low cost primary care for their patients.

HIN: CMS and top-performing Pioneer ACOs are heavily invested in bundled or episode-based payments. Will more private payors embrace this reimbursement method as well?

(Catherine Sreckovich): Definitely. The bundled or episodic-based payment approaches are here to stay. We’re starting to see this take off in a number of states. For example, there are state innovation grants that CMS has provided to states like Arkansas, Ohio, Delaware and others looking for opportunities to implement multi-payor bundled payment initiatives. Although these are not necessarily the traditional ACO model, they built off of that ACO model.

We also see that the large health plans in various states are starting to build and develop ACOs. Key to these are the shared savings arrangements that they’re implementing with these payment approaches. So whether they’re bundled or episodic-based payments or whether they look more like a traditional ACO, if there is such a thing, we’re starting to see takeoffs on those kinds of models as payors and health plans become more creative in the development of their alternatives.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Healthcare Business Week in Review: Childhood Obesity, Dual Eligibles, ACOs, Patient Activation Measures

November 1st, 2013 by Cheryl Miller

Last year at this time we watched with disbelief as Hurricane Sandy pummeled our East coastline. Schools closed, power shut down, and Halloween was officially postponed until early November when it was considered safe for children to trick or treat.

Our own town is still recovering from the storm; scarred, vacant houses share the same block as rehabbed homes on stilt-like platforms; trailers double for once elegant restaurants and broken docks and abandoned boats patiently ride the crests of ocean waves.

It was a rocky year for healthcare as well, from an early surge in Medicare ACOs, to the embattled introduction of ACA-mandated health insurance exchanges during a government shutdown.

But many things remained the same; childhood obesity rates continued to climb , as did public health efforts to control it, including counseling and nutritional guidance, according to a new trends report from NCQA. Poverty continued to plague many Americans, particularly dual eligibles, but companies like Wellcare did their best to help them by closing social gaps with health-oriented community connections looking to “give back,” as its vice president of advocacy and community-based programs executive director Pamme Taylor demonstrates in this week’s featured book excerpt.

Organizations like HealthEast and Mercy utilized clinical analytics technologies from Optum to better understand and manage treatment for patients with chronic conditions, and advance performance for its newly formed accountable care organization (ACO).

And doctors’ policies toward accepting new Medicaid patients in the wake of expanded coverage will most likely stay the same, according to a study from Virginia Commonwealth University, Richmond. The decade-plus study found that physicians might be more likely to stop accepting those patients who remain uninsured, however, as our story details.

And lastly, self-management continues to result in better patient outcomes, according to researchers from the Boston Medical Center. Patient activation, or having the knowledge, skills, and confidence needed to manage one’s health, leads to better health following hospital discharge, and lower readmission rates. Screening for patient activation could not only help hospitals identify patients at risk for readmission, but also inform the development of tailored, cost-effective intervention plans.

How did your healthcare organization fare in 2013? And what plans do you have the future? Tell us by completing our ninth annual survey on Healthcare Trends for 2014 and you’ll receive a free executive summary of the results. One respondent will win a training DVD of the “2014 Healthcare Trends and Forecasts” webinar recorded on October 30, 2013.