Posts Tagged ‘accountable care’

Infographic: Hospital Adoption of Alternative Payment and Delivery Models

May 18th, 2018 by Melanie Matthews

Hospitals and health systems continue to test and adopt alternative payment and delivery models, such as ACOs, medical homes, and performance-based payment, according to a new infographic by the American Hospital Association.

The infographic examines market trends for value-based payment and delivery models.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

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).

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Infographic: Top Accountable Care Organizations

March 24th, 2017 by Melanie Matthews

There are over 700 accountable care organizations (ACOs) across the country, according to a new infographic by SK&A, with California leading the way with the most ACOs.

The infographic examines each state’s ACO ranking by the number of ACOs as well as the top five ACOs by the total number of participating physicians.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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Infographic: ACO Trends

January 23rd, 2017 by Melanie Matthews

Momentum in value-based care has been building over the last several years, and 2016 was no exception, according to a new infographic by Oliver Wyman.

The infographic maps out the more than 630 ACOs in the United States.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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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: Delineating Accountable Care Responsibilities

May 25th, 2016 by Melanie Matthews

States introducing accountable care organization (ACO) programs into an existing Medicaid managed care environment will need to assign responsibilities between ACOs and managed care organizations (MCOs). Successful delineation of responsibilities can support ACOs and MCOs in complementing one another and being better positioned to improve care delivery for Medicaid enrollees, according to a new infographic by the Center for Health Care Strategies Inc.

The infographic identifies five responsibilities that both ACOs and MCOs may share and outlines which entity may be better suited to perform each function.

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: Trends Impacting the Healthcare Workforce

December 25th, 2015 by Melanie Matthews

Aging demographics, population health, accountable care initiatives, and the rapid growth of retail healthcare clinics are all affecting talent management practices in the healthcare industry, according to a new study by HealthcareSource and the American Society for Healthcare Human Resources Administration (ASHHRA).

A new infographic by the two organizations breakdowns key data points from the study.

From cost pressures, consumerism and consolidation to a proliferation of patient-centered, value-based delivery and payment models, the state of healthcare continues to challenge organizations in the industry.

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry, HIN’s 12th annual business forecast, pins down the trends destined to impact the industry in the year to come and proposes tactics C-suite executives can employ to distinguish their operations in a dynamic marketplace.

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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: 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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5 Market Trends Impacting Value-Based Reimbursement: “It’s Not Just About Volume”

July 31st, 2014 by Cheryl Miller

Accompanying the move to value-based care and reimbursement is the need to align economic and practice incentives to create accountability, says Cynthia Kilroy, senior vice president of provider strategy and business development, Optum. It is not just about volume, but about managing populations, and investing in capabilities and tools to manage populations.

We are seeing five trends in the industry, with implications for each of them.

First, there is a consolidation of the provider community that physicians are organizing, and then hospital systems or large integrated delivery networks (IDNs) are purchasing physicians. We are seeing both an affiliated and an employed model in the market right now.

Another trend is system affordability. Premiums have been increasing significantly — more than 30 percent over the last five years. The challenge that CMS and some payors are focusing on is how to make healthcare more affordable to the community at large.

A third trending area is value-based care, and aligning the economic and the practice incentives to create accountability. It is not just about volume, but about managing populations. This leads into the fourth trend, which is that provider organizations are investing in capabilities and tools to manage populations. Then the incentive models are moving more around that population care, which is more challenging to measure.

Finally, there is a significant amount of interest in finding performance metrics. There is HCAHPS®. Every other payor is asking for different performance metrics from organizations; how do we focus that into the right incentive, especially from an incentive program for physicians? Each organization will be trying to achieve something different; each market is very different. I may see one provider organization focus in particular areas and disease states around quality. In other markets there might be something completely different. It is based on what is going on in that particular market and practice.

Excerpted from 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability.

Narrow Networks Top Payor Product Innovations List for 2014

June 17th, 2014 by Patricia Donovan

If recent market data is any indication, employers are gravitating toward narrow networks in greater numbers. For instance, a March 2014 Wells Fargo Insurance survey of more than 70 insurance companies placed narrow networks among the top three employer product innovations in 2014, along with are accountable care organizations (ACOs) and increased wellness programs.

In just one example, Harvard Pilgrim HealthCare this week introduced ElevateHealth℠, a partnership with Dartmouth-Hitchcock and Elliot Health System that is a non-profit, high-performance, defined-network product offering access to premier hospitals and providers in New Hampshire.

With its emphasis on care coordination within the network, ElevateHealth insurance premiums on average offer 10 percent savings compared with Harvard Pilgrim’s similar full-network plans, the insurer said.

And last month, UnitedHealthcare announced it would cut 2 to 4 percent of the physicians in its Medicare Advantage network in some Virginia service areas.

In theory, narrow networks—and their close cousins, tiered, tailored and high performance networks—sound like a good thing: health insurance products that group providers into tiers based on their cost or efficiency of care, then steer patients to choose these providers through lower premiums or cost sharing.

In practice, however, some consumers served by narrow networks are balking at the difficulty of obtaining appointments with network providers. Earlier this month, the Wall Street Journal reported that insurers in several states are expanding hospital and physician networks for plans sold through the Affordable Care Act’s health insurance exchanges amid gripes from patients and state officials about limited provider choices.

Anthem Blue Cross, Blue Shield of California, Health Net and WellPoint are among insurers that have substantially expanded provider networks in its exchanges, the article stated. And more providers are slated to join Harvard Pilgrim HealthCare’s ElevateHealth’s network beginning in July.

Earlier this year, industry thought leaders analyzed what the proliferation of narrow networks means for healthcare. Steven Valentine, president of The Camden Group, talked about the impact on both providers and consumers.

“First of all, we anticipate an increase in the number of covered lives,” Valentine said during HIN’s annual healthcare trends forecast. “Providers are going to see an increase in patient volumes, especially primary care providers. And especially providers in states that have opted to stay in Medicaid.”

However,” he continued, “Many of the qualified health plans have narrow networks, so patients are probably going to be confused about which doctors are in their networks and probably will shift around until they can find the right place for them.”

Providers in networks with bronze plans will probably have much higher increases in patient volumes, he predicted. “And other providers will probably see some shifting until patients can figure out where they need to go.”

Regardless of the confusion, Valentine expects the trend of narrow networks to continue. “We clearly see narrow networks operating in conjunction with tiered benefit plans; that is, a lower premium, a more narrow network. We’ve clearly seen that in some of the exchanges as we look at the various medal options that are available. Narrow networks are here to stay; they are not going to go away.”

Catherine Sreckovich, managing director in the healthcare practice at Navigant, concurs. “I agree 100 percent. We’re going to see [narrow networks] more and more. And to the extent there continues to be competition in the exchanges and more health plans trying to get involved, this trend will continue.”

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