This week, the Centers for Medicare & Medicaid Services announced 2014 results for 333 Medicare Accountable Care Organizations (ACOs). It’s pretty exciting news; 56% of ACOs reduced costs and improved quality measures and reporting, which is up from 40% in previous years. The downside of the report is that only 29% of ACOs participated in shared savings, which is simply not enough. The ACOs are saving money, but they’re not earning revenue at the same rate. It’s clear that we, as in industry, have to do more to facilitate success. Think like a payer To earn shared savings, ACOs need to think more like payers. Unlike traditional fee-for-service models, new value-based-care models require providers to balance risk scores and quality measures for better patient care. They have to manage patient coding to account for risk, which is what payers do […]

In a healthcare industry that is shifting from fee-for-service to value-based-care models, it’s increasingly important for practices to understand everything about their costs. To that end, Centers for Medicare and Medicaid Services (CMS) delivers a claim file to Accountable Care Organizations (ACOs). Unfortunately, ACOs often don’t take full advantage of the intelligence available within the CMS claim file. But if ACOs can unlock these “mysteries” held within the file, they can reduce costs more quickly. Here are just a few examples: Where do all my patients receive care? Your CMS claim file can show you where your patients are actually receiving care. The answer may surprise you. For example, we helped one of our ACO clients in the rural Midwest plot on a map where its patients were receiving care. As expected, patients received a lot of care in the […]

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4 essential steps to forming an ACO

January 2016 may seem like a long ways off. But if you’re thinking about forming an Accountable Care Organization (ACO) for next year, the clock is already ticking. The fee-for-service reimbursement model is shifting to value-based-care financial models, such as an ACO. The U.S. Health and Human Services (HHS) set a goal of tying 30% of its payments to these types of arrangements by the end of 2016, and 50% by the end of 2018. Now is the time to start planning. Here’s a checklist of the essential steps organizations should take in 2015 to be ready to start an ACO in January: 1. April & May 2015 – Decide if the ACO model is the right one for you. Assess your current situation with questions like these: Are physician incomes going up or down? Are your physicians properly aligned […]

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An ACO rookie’s most common mistake

To stay competitive in an evolving healthcare landscape, independent small physician practices are creating their own Accountable Care Organizations (ACO). It’s important for them to have accurate expectations before applying to Center for Medicare & Medicaid Services (CMS) and its Shared Savings Program. Unfortunately, new ACO applicants often miscalculate the number of CMS patients, or “attributed lives,” they are responsible for, putting their entire cost structure at risk. Whose patient is it? CMS assigns each patient to a provider who will be responsible for that patient’s cost and quality of care. A sophisticated algorithm determines where this patient belongs, based on claims data. A smaller primary practice may assume that every History and Physical (H&P) it performs for Medicare patients will count toward its attributed lives total, when in fact that is not the case. For example, if that patient […]

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Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices. To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future. The cost of unmanaged cardiac conditions One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage. With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average […]

Small, independent physician practices have the best of healthcare IT worlds, and the worst. On the plus side, they can control everything that happens inside their walls. They have access to their clinical and financial data. They can be more nimble with Healthcare IT decisions than larger organizations, from selection to implementation to governance. But if small practices don’t have analytics, they could be losing money. And they may not even realize it. Most practices don’t have the right tools Small practices likely have reporting tools in their electronic health record (EHR) and practice management solutions. “Canned” reports can help track and monitor certain aspects of a practice, which is essential to having a healthy core. But it takes more sophisticated analytics tools to really understand things like referral patterns, clinical pathways, care coordination – especially in context with cost […]

The popularity of a recent blog post, 6 tips for achieving Meaningful Use Stage 2, shows there’s a lot of interest in real-world experience and advice on this topic. Physicians’ Alliance, Ltd. (Lancaster, Pennsylvania, U.S.A) just completed a whopping 61 Meaningful Use Stage 2 attestations in the third quarter of 2014. We learned more about their experience from IT Director Barbara Eberly, Physician Practice Liaison Nancy Snavely and Quality Initiatives Coordinator Vicky Martell. Much of their sage advice echoed that from fellow Allscripts TouchWorks® EHR and FollowMyHealth® user Coastal Carolina Health Care, and they had a few additional tips to share: 1. Physicians need to champion the portal Barbara Eberly: When we launched FollowMyHealth, we started with the usual tactics: bulk invitations, posters, temporary employees who enroll patients. But it still didn’t get us where we wanted to be. Reports showed […]

According to recent quality reports of 220 Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP), Coastal Carolina Quality Care ranked third overall and second in care coordination. This ACO and its associated physician practice, Coastal Carolina Health Care (CCHC), use Allscripts TouchWorks® EHR and FollowMyHealth®. We recently interviewed CCHC Chief Executive Officer Stephen Nuckolls and Associate Administrator Carrie Hagan about their success with MSSP and the Meaningful Use incentive program. For 2014 four providers attested for Stage 1, and 38 providers attested for Stage 2. What’s the secret to their success? Nuckolls and Hagan share these six tips for achieving Meaningful Use Stage 2: 1. Allow plenty of time Carrie Hagan: “We started the implementation process back in November of 2013, working towards attesting in the second quarter of 2014…We wanted that intense focus for a longer […]

Craig Dreher, chief information officer at Mercy Health System (Portland, ME, U.S.A.), recently observed, “In the Accountable Care Organization (ACO) environment, you have to do everything exactly right. You get paid only if you meet certain measurements. Can you imagine applying those standards in other places, like the airline industry?” That’s an interesting thought. Instead of a set price in advance for each flight, what if airlines could only receive payment upon meeting certain measurements? The flight must take off and land on time. Gauges must prove that the plane used correct amounts of fuel and oil. The pilot reports in a timely and precise manner to air traffic control. This is what is being asked of medicine. What if consumer behavior also contributed to whether or not airlines receive payment? All passengers must stow their carry-on baggage safely and […]

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  Nursing is the world’s largest healthcare profession. As the industry evolves to new models (such as value-based care*), it significantly affects nurses in acute settings, home care, case management, clinics and all venues of care. To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject: How is health care’s shift to value-based models affecting nurses in your organization? “I think in a positive way. We focus on communication and on setting and sharing expectations, using value-based equations to explain why these are the right things to do. We work hard to make sure our goals tie together – from the University of California, to the department, to the individual. “For example, about 18 months ago we held […]